Okay, but would you still go private if you knew it cost this much?

Posted on Jul 28, 2012 | 21 comments

Here in Britain, it is easy to forget just how much medical care costs. We think of the NHS as “free” since it is, on the point of delivery. Of course, it isn’t “free” – nothing like it.

It is no wonder we appreciate the NHS. It is one of the best health care systems in the world, and we never have to worry about being turned away because we can not pay. It must have been completely baffling for people around the world to see Great Ormond Street Hospital (a London children’s hospital where May is seen for her vision) and, most prominently, the NHS featured as part of the London 2012 Olympic Ceremonies. But, in my house, we cheered.

We were at an equally good hospital, The Detroit Children’s Hospital, with May when she was three months old and saw for ourselves a little boy discharged, not because he was ready, but because his insurance ran out. Such cruelties will never happen to May.

The downside is, that sometimes – rarely – the NHS doesn’t work and when that happens, we are out of luck.

Unless, we go private. This probably seems like the obvious solution. If the NHS doesn’t provide, pay for it. Health is too important to mess around with. I did it myself, and continue to do so, with May’s private physio. It is very costly, but we can’t afford to do anything else for May.

We are at those crossroads right now. May has already waited nine months to see a specialist about her hips. Most readers of the post felt that we should go private.

But, what would you do if you knew exactly how much it would cost? Yesterday, I received an emailed estimate. Here is how it added up (USD conversion correct as of today):

Initial appointment = £250 ($394)
Follow-ups = £175 ($275.56)
Up-to-date x-rays = £242 ($381.07)

Total = £667 ($1050.29)

That does not include surgery. If it comes to that. And, I don’t even want to think about how much that would cost.

The email with the costs, included the specialist’s advice that we wait. He said another doctor is joining his team in September which should alleviate the strain and allow May to be seen as early as October.

Now, what would you do?

21 Comments

  1. Depends on how her hips look (for me to make that decision but I might have an advantage on how to decide. Assuming your private physio agees surgery is necessary.)

    Really it is the same here in US. Consider all insurance as compositeNHS. (NOT free, as you correctly say.) Also it is illegal to discharge based on ability to pay In US. But, the pt might not get the care they think they need (hip surgery).

    How do you know that May’s surgery is not denied by NHS because of cost? HOw do you know whether May’s surgery is denied by the NHS because she is disabled?

    The point is, insurers, gov or not, get to decide on treatment.

  2. Sometimes just paying for the initial appointment will get you seen sooner. It’s a judgement call but have you thought about fund raising? I have seen people receive enough money for stem cell treatment.

  3. If you spend the $1000 you will know if she needs the surgery and then you can wait to have it done free. I understand you liking the free system but if you have to wait a year or two to see a specialist how good is it really? Do emergencies get seen faster? I assume they do. I wold hope they do. But it seems you wait a long time for most things. I like to be seen when I first notice the issue. But that is just me and I can afford it. For those that can’t that is when it becomes a real issue. If waiting makes no difference then wait, if it could really change May’s quality of life I say pay for it privately.

  4. I would still pay. $1050.29 is not expensive, in my opinion, when it comes to your health and I’m a poor college student. You would get the appointment and the piece of mind of knowing what May needs. You don’t have to sign up for the surgery the same day.

    I was told if I didn’t get insurance my Remicade for my Crohn’s would be about $3000 a month, and I was ready and willing to go into deep financial debt to receive it. Thankfully, New York State is awesome and I was able to get insurance. It still costs me $20 a month as a copay. I’m having surgery this coming Monday and that’ll cost about $275+, with insurance. It’s at least $200 for surgery, $75 for the OR, and $10 to anyone that assists with the surgery.

    As for the kid that was discharged, apparently, some insurances work like that … they get discharged for a day or something and then readmitted the next day, or couple of hours. When I was in the hospital for 7 weeks, when I was younger, my Mom’s coworker asked her if her insurance company made me do that. They didn’t.

    Adrianne

  5. Actually, the amount you’d be paying for private is similar to what I’d pay with insurance that also costs $800/month for my family to have. :) But, I’d be tempted to wait till October. That isn’t so far away from now. That new standing walker may help tide her over.

    • We pay every month towards the NHS as well, through our taxes. We just don’t pay on top of that. There are exceptions (prescriptions cost £7.65, for example, though May’s are free).

  6. If you can afford it, and I realize that’s a big “if” given all of your other expenses, I would go private until the NHS waiting list catches up with her. If you take a private appointment now, would they kick her off the NHS waiting list? If not, presumably once her number on the NHS list comes up you could switch over to being an NHS patient again. (And you would make sure that surgery didn’t happen until she came up on the NHS waiting list.)

    But £667 is a lot of money that could pay for a lot of physiotherapy, so reasonable people could differ. Especially if the October appointment is something that is realistic.

    Ugh, what a horrible choice. I think the NHS is great, but this here is one of its biggest problems. If a sick child (or a sick anybody) can’t get the care she needs, then what the heck are they doing? I suppose the answer is, the best that they can– but that’s just not good enough here.

    On your other point, I thought at first that the Olympic opening ceremony was an exceedingly eccentric sort of inside joke that no one outside the UK was going to understand or like. Until they got to the Great Ormond Street Hospital patients. Only Britain would find it completely natural to use a world stage to give sick children the time of their lives.

  7. What about both? Do the first ($400) app’t, then see. You can get more x-rays thru NHS, and followup in the fall with NHS (since it sounds like its all the same docs)? Our (us) insurance covers some but not all. I wrote a check for $175 on Thursday for an OT that was amazing – I could have spent $25 (co-pay) at our local children’s hospital for an OT that did not even seem to share the same speciality. If the OT can swing it she will see my son 2 more times this summer. Those visits ($500) plus at least $100 in supplies – and that’s just his OT. I need a crown but used up all of my coverage on an emergency root canal ($1200 for the crown). My son also needs a series of dermatology app’ts that may cost a whole lot more than $25/visit….no system is perfect. We can afford just about all we need as a family but we are lucky to have good insurance…And, like so many things, it’s a balance. Good luck in making your decision.

    • I think the problem is that the secretary implied that if we start private, we continue that way. But, then, I’ve heard different from other people. I’m definitely looking at all the options. I agree – no system is perfect.

  8. I’d say yes, go private for the initial appointment and then have a re think.

    If you do go down private route then you can go back to NHS at anytime.

    I’m sure the private secretary would love you to think you have to keep on that path, as it’s more money in their pockets if you do.

    As with everything, keep reevaluating after every appointment and see how you get on.

    xx

  9. I am going private on maternity care this time, because my experience with little L was so traumatising, we vowed never to expose ourselves to the randomness that the NHS can be at times.
    Cost wise, it’s a bit of a nightmare. (Bye bye, holidays 2013…) But absolutely worth it, in my opinion.
    I’d be surprised if the NHS wouldn’t take you ‘back’ if you decide to go for the initial private consultation. I can at any point go back to the NHS, if I want to. Why would it be different for you and your daughter?

    • I considered it as well. In the end, we were referred on to high risk obstetrics team and obstetrician in-charge was one of the ones we would have paid for privately. Bit of luck that! He did make a world of difference.

  10. Perhaps you could see if May’s hospital would do repeat x-rays to be reviewed by their general orthopaedic sugeon to see if her hips have remained stable, or whether there’s been any change. Then if they have migrated further this information could help you to either request a sooner appointment with the specialist on urgent grounds, or decide to go private. You’ve probably already looked into this option though.

    Our son has migrating hips too, 30%, which is desparately worrying. He was diagnosed last December when he just turned 3. He’s just been x-rayed again and thankfully is stable at the moment, although this is likely to change and he’ll need surgery at some point in the future. We’ve been fortunate in that we’re already on a specialist paediatric orthopaedic’s books, but he’s still only going to review Tom every 6-9 months unless there’s obvious change to the position of Tom’s hips (ie. it becomes hard to change nappies or if he’s in pain). The advice we’ve been given is weightbearing and stepping like you, stander and walker. Although a walker’s proving hard for Tom to use – I was inspired by May in the Kid Walk – we’re going to get the Leckey rep out.

    Good luck – I find it so hard to make these kind of decisions when going through it all for the first time, however hard I research and plan inevitably most of my knowledge is retrospective, as it’s nigh on impossible to know what something really means or entails until it’s actualy happening.

    • If you do go for the Leckey, Laurence who was our rep was a great guy. It is definitely worth a shot. Our physio said she’s seen children far worse than May use it, and May’s disabilities cognitively and physically are pretty severe.

      And 100% I agree on the seeing things in retrospect. No matter how much research or planning I do, inevitably there are things I press for that later have no impact, or things that would have been invaluable that I had no idea about! Also, in regards to the x-ray, they already plan on doing another one, it’s just we have to wait for that appointment for it to be requested. Which is very frustrating.

  11. Just to add to the above – I think it’s standard practice to do a hip x-ray for a child with cp whose at risk of dislocation every 12 months. Once diagnosed I would have thought that this would increase to 6-9 months. So whilst you’re stuck on the specialist’s waiting list, surely May’s physio and consultant should still be responsible for ensuring these x-rays happen.

  12. If you think getting in now vs. waiting until October would help May, do it now. And hit up your friends and family with a fundraiser :)

  13. Do you have a local mom group of sorts you can poll?
    From my experience in both England (NW London) and Israel, talking to Americans about these decisions is really difficult. I’m in the US now and it’s just so difficult to explain and translate between the public/private system and the US-craziness.

    My personal opinion is that if you think that it’s important to not wait, just don’t. Expenses be damned. If you and the doctor think it’s just the same to wait til October, wait. Whatever you do, don’t be afraid to wait and change your mind. People tend to stick to a decision, but if you wait it out and decide in September you can’t wait anymore, don’t give yourself grief. Just go.

    It’s really helpful to speak to people who are going through the same system as you, and who have gone through it. I’m new to your blog so I apologize if this is something that you’ve discussed, and I’m sure you do talk to people, but I know I’ve really struggled with trying to explain to relatives worldwide what’s going on with us in different countries.

    Just to quickly answer the question someone asked: of course emergencies get seen faster. The down side to socialized care is that the in-between situations can take a while. However, this is also true in the US in certain areas (like where I live in some fields). You can then go private, which can be more than in the US, or cheaper than a US deductible and coinsurance (my current insurance only kicks in after I’ve spent $1000.)

  14. Also, I would ask about the likelihood/possibility of being seen privately now and then having the surgery, if necessary, and continuing on through NHS. Make sure you can keep your NHS spot, so to speak.

    Do you have any idea as to whether having the appointment earlier (done privately) might make surgery (on NHS) happens sooner, if necessary. Or would she still be on the waiting list for as long. If the latter, is there a point to having an earlier appointment, unless you are committed to going private all the way? Just thought, sorry I’m not more helpful…

  15. People misunderstand the system here in the US. Yes, most people do pay for private insurance. But if you are poor or disabled you qualify for Medicaid in most states and that will cover everything. In fact, when my husband was in law school our entire family received Medicaid and we saw the best doctors in the state that we lived in (and we never had to wait to see them). I had 2 surgeries, had a baby via c-section, took my children to PT for various things and took them to specialists and we never paid a single penny. Nor did we ever wait more than a few days for an appointment. On another note, we also had free housing and free food the entire time my husband was in school. Later after we had moved to a different state, my husband had a job, and we bought a house. And then lost his job. Again, in a different state, we qualified for Medicaid and food stamps. We were able to stay on Medicaid while my husband looked for work, found a part-time job, moved to full time and then finally we transitioned to private insurance. My children were able to stay on the state program because we qualified based on income. Turned out to be a huge blessing as our 3rd child is disabled. Thus far I have not paid a SINGLE dollar for my child’s therapy. The county we live in provides free therapy for any disabled child regardless of income. We also get free private therapy at the center of our choice. And we have never waited more than a week to see a doctor or schedule an MRI or anything. What gets tricky is if you have private insurance and make too much money to qualify for Medicaid. However, many states will provide care for disabled children regardless of income. And as a previous poster commented, a hospital cannot legally refuse treatment to a patient. If a person had a very sick child it is likely they could go back and qualify for Medicaid after the fact if they didn’t have insurance or if their child was very sick and their private insurance wouldn’t cover all their bills. The biggest problem with the US system is that it is complicated and you have to learn how to navigate it. But I know many, many, many families with disabled children that are all on Medicaid and they receive excellent care, from the best doctors and they don’t have to wait, or pay extra to get an appointment.

    • This is really interesting. I haven’t heard this perspective. Of course, you make the point that – due to income – you qualify for Medicaid. What a relief after discovering your third child was disabled. In the hospital, when we discovered about May’s condition, one of the saving graces was not having to argue with the insurance company. I wonder what we would qualify for if we lived in the States. Both of us are teachers… I really don’t know.

      • Well, the income limit for children’s medical program is based on number of people in your family. . it is fairly high for the children’s program (around 60K for a family of 5 in our state). There are also waivers you can apply for if you have a disabled child to permanently qualify for Medicaid as well as social security income. Also, Early Intervention (which is just therapy, no doctor’s visits) is available to most disabled children and not based on income at all in many states.

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