Re: Question for DR. SANCHEZ

Thanks Dr. Sancha (as always - you are a gentleman and a scholar). I guess
there must be a lot of affluent people in Spain who need PVP's, since they
have to pay cash price :-) . Rule of thumb in the U.S. for the indigent or
non insured (I am not talking PVP's), the doc's have two sets of books IMO
(which has always pissed me of). This is not advertised of course and is my
opinion, but I can prove it by my own experience with a general surgeon who
dropped my insurance. The old time doctor's are especially kind to their
older patients, I believe.

What they do is charge the insurance company one price and the ins comp pays
the allowed amount which is way less than the price charged (say 25-50%),
could even be less for the cheap ass ins companies. If they go to low, then
the doctors start dropping them which has happened to my blue cross federal
ins. It used to be one of the best in the world and now it is one of the
worst because their allowed amounts are dropping too low.

But if someone doesn't have insurance at all (or if the surgeon doesn't
accept the insurance), the doctor may give the person a break (call it a
professional courtesy) and only hold the patient responsible for say 50% of
the amount they charge for the procedure to an ins company. I'm sure you
know what I'm talking about. I would expect that you only have one fee for
your PVP's since they are not covered in Spain anyway, although you may give
the less fortunate people a break, but I guess that could get tricky.

This what I call "two sets of books" in the U.S. has always bothered me,
and IMO is a game between the insurance companies and the providers. But it
is nice that the providers at least will give the patient without insurance
a break (i.e. they could charge him the full price if they wanted to, and a
lot of doctor's will try to do that, and you have to write them a letter
requesting a professional courtesy).

All of what I am talking about mainly applies to surgery. In the U.S. most
people who have insurance only go to what we call preferred providers
(PPO's), but the problem is that when you have surgery there are at least
four (and could be more) separate bills you get (i.e. surgeons fee, facility
fee, anesthesiologist's fee, and pathologist's fee as a minimum - could also
add radiologist). So all the patient can do is make sure the surgeon and
facility are covered, because it becomes too unwieldy to control all four or
five of the charges involved.

Hope I didn't bore you with our U.S. stuff. I'm sure you already know about
it. Take care...Pete

fgomsan@xxxxxxxxx wrote:
> Pete,
>
> Bigger glands need more time and more fibers. This means more cost for
> the patient. Patients tell me often that what I propose is more
> expensive than what some other surgeons do, but I tell them It is what
> it takes to get a good result and to do a good job. Insurance
> companies in Spain do not cover this procedure yet. They only cover
> procedures offered by the national health services, so I guess it
> will take a year or two before they can start covering it.
>
> I must say though that although I am very agressive with PVP in a
> patient who is 50 years of age, with the intention of avoiding the
> need for reoperations in the future, I might not be so aggressive in
> an 89 year old catheterised patient. If his life expectancy is short
> maybe there is no point in being aggressive, because long term
> survival is not expected. I just make sure the patient will void well
> without a catheter and that's it.


.

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