In both our cases you have a preliminary exam or two where they figure out what to do, measure your eyes, etc. on a wide variety of funny blinking
machines. Then you have the day of surgery. The very next day you go for an exam to ensure things worked out, and then again a week after that. So
during the second week I had surgery on Tuesday, follow my follow up on Wednesday, her surgery on Thursday, her follow up in Friday. The following
week it was my week follow up on Wednesday, her other eye on Thursday, her follow up on Friday. So other than the preliminary exams, it took about a
month from start to finish.
Interesting point for her: No makeup, including eye shadow, eye liner, or mascara. Why? Potential contamination that could start an infection. This is
in effect for a week after her last surgery.
You become very familiar with these. If you don’t know how to do it, you’ll learn. I hate them, and I have this theory about it: The Caveman
theory, which I tell every eye doctor. The idea is that I have a million years of evolution telling me I should never let anything close to my eyes.
Science has 200 years. Guess who is going to win? My optometrist of many years has already been trained and makes fun of me, but these new guys need
direction. It’s better if I do it myself. What eye drops? Ketorolac Trimethamine (stings like an SOB), Prednisolone Acetate, Polymyxin B Sulfate and
Trimethoprin, Ofloxacin. You start these drops prior to your surgery and keep them going up to two weeks after up to four times per day. They are
designed to prevent infection, inflammation, itching, allergic reactions, etc. So basically every three to four hours you go through a round of this
stuff, five to ten minutes apart. By the time you get to the end of it you ought to be pretty good at it. Cost depends on your plan. For me it’s
$4.00 a bottle, which is from 5 to 10 ml each. Tiny little bottles that all look alike. You can tell the difference by the color of the cap because
one is a slightly different shade of lavender.
Insurance and Costs
We are both old enough to be on Medicare Advantage plans. This is a bit complicated. As you probably already know, Medicare by itself is not enough
insurance to cover you. You need some sort of supplemental plan. Also, even though we’ve been paying into Medicare monthly since the whole things
started in the sixties, we also pay a premium taken out of our social security checks. That “covers us” for Medicare. Now, a “Medicare
Advantage” plan is a little different. For these plans your monthly Medicare premium that you pay is assigned to your insurance provider. They get
that money every month. In addition, they charge you every month, so the insurance company gets some money from the Feds, and some money from you.
Supplemental plans are not all “Advantage” plans. You can get supplemental plans from paces like AARP. Generally speaking, Medicare plus
Supplemental is more expensive than “Medicare Advantage.” This is one of those areas where YMMV and depends even on where you live.
Now, when you go to the doctor or have a procedure, the doctor or clinic bills Medicare and Medicare pays a part of that fee. Most of the rest of the
fee is covered by your “Advantage” plan, but you usually have a modest “co-pay” for every visit. Except for surgery where the “co-pay” is
far larger. More on that below. Both my wife and I have been with our respective clinics and doctors for many years, since the seventies. When we
retired neither of us wanted to switch. So I belong to an HMO (Health Maintenance Organization) called “Group Health,” which is local to western
Washington. It just got absorbed by Kaiser Permanente. They have all their own clinics and doctors, so you must go TO THEM, unless they can’t do it,
which in this case, they could not. So I was referred outside the organization. The upshot: I pay $28.00 per month to belong to Kaiser Permanente.
That’s how much I pay per month for health insurance.
My wife has been with a place called Virginia Mason as long as I have been with Group Health. To get her into a Medicare Advantage Plan we had to use
an outside insurance provider. You see, Kaiser Permanente is their own insurance. That’s a big difference. For her we use Regence. It works the same
way. Regence gets the Medicare premium, and they charge her a monthly fee: $167.00. Way more than for me, right? Couldn’t my wife have joined Kaiser
Permanente? Sure. Did she want to change doctors? Not in your life! But look: $167.00 a month for full coverage? Not bad. $28.00 a month for full
coverage? Unheard of. Private insurance without an Advantage Plan around here would be $750 per month apiece. I’m just fine with these prices.
I’m sure one of these days Kaiser will say they forgot to add a zero.
Here’s where it gets weird. Regence, bless their hearts*, considers cataract surgery “elective” surgery. It’s not a heart attack so no
emergency, right? You can choose when to do it. And cataract surgery that involves a toric lens to correct astigmatism is REALLY elective surgery. So
the Co-Pay is $1,300 per eye. Apparently it is “elective” that you continue to be able to see. I mean, you could correct astigmatism with
glasses, right? You don’t need a fancy expensive inter-ocular lens to do that. So we’re out $2600 for her surgery plus some office co-pays. (The
figures below show a little less.)
My surgery Co-Pay is $250 per eye. It’s $250 for ANYTHING, no matter what. So my cost is $500 plus a few modest co-pays for these office visits.
I’m probably out about $600 altogether. It hasn’t quite settled out yet, but I’m very close. So for a $28 per month premium I pay $600 for
cataract surgery. For $167 per month she pays about $2700 for cataract surgery. YMMV.
Full Disclosure. It’s even MORE complicated. Before my wife retired several years ago, her employer (mine, too, a public library) was grappling with
how to fund health care for staff. The premiums were out of this world, but they could be significantly reduced if the co-pays were higher. But there
is such thing as a HRA/Veba account, a “health maintenance” account, where the IRS allows an employer to set up a tax-free account for every
employee. The employee then draws on this account for co-pays using what amounts to a special Visa credit card. You do not have full control of this
money and must abide by HRA/Veba rules for expenditures, keep receipts, etc. She had accumulated about $2900 in this account, which has been sitting
there for years. Bottom Line is that we were able to use that money to offset the surgical co-pay. Of course, that money is not there any more. We
just used it up, but we did not need to take it from our monthly income.
Cost for her: $9,591.00 of which we paid $2,200.00
Cost for me: $7,948.00 of which we paid $615.00
Cost my clinics billed: $27,368.00 (Nobody paid this)
* "Bless your heart" is a Southern phrase that means, "You're an idiot!"
edit on 7/21/2018 by schuyler because: (no reason given)