Health - Trigger Finger Costs

Oct 24^th 2017

We went yesterday for my pre-surgery dr appt for my right ring finger.  It has been two years since I saw Dr Araujo here in Trinidad.  He suggested we try one more cortisone injection but left it up to me to decide.  While I doubt that is going to do it, I had to try once more, so that is what I got yesterday.  In the past, it works for a bit and then the trigger finger comes back.  I have a follow up in a month.

Now for the interesting details of the visit that make it so different from the USA and probably the reason the pricing is reasonable down here in the Caribbean.

• First, we met in the doctor's actual office, not an exam room.  It is so much nicer.  He has an exam room off his office so we went in there for the actual exam but then back into his office for the wrap up.  Nice.
• Second - other than checking in at the front desk, the actual Dr is the one we saw next, not a PA, RN, or other, but the actual Dr.  He was the one asking what was going on.  
• Third - He did an ultrsound on each hand.  He did it himself, not someone else.  *I have trigger fingers in each hand - at this point ring and middle on each hand but only the right ring is really bad. 
• Forth -He did the injection himself.  An office staff brought in the dose and supplies but he did it.  This involved freezing the area, numbing with a local and then waiting for that to kick in (5mins - in which he typed on his computer notes to my file and yet continued to chat with us) and then did the actual injection.

Trigger thumb - left not working like the right

In the USA I would first see a med staff of some sort who would gather information.  Then a PA or RN to do a brief exam and diagnosis and then the Dr to give the final diagnostic.  Any ultrasound would have been in radiology and if in a hospital, read by a radiologist and then sent to the Dr.  In a clinic it would have been done in radiology dept and then sent to Dr for reading.  My injections in the USA have always been given by the PA, never the Dr.  

Billing in Trinidad - Dr fee (by the way, Dr Araujo is a board certf. Orthopedic doctor with training/schooling in Trinidad, UK and US) $600TT -approx  $100US.  Ultrasound was listed as one for $400TT - approx$66US.  The injection was not even listed. 

Trigger thumb fixed in USA several years ago

Billing in the USA - first of all, good luck even pricing healthcare costs of any sort before or during.  It is really hard, seriously.  I have not done an in depth lately but a cursory look online yesterday said the cortisone injection alone would be anywhere from $116 to $343 in our zip code.  One search said a hand exam would be approx $1000+ but that is very rough estimate as there were no details and unknown if this was with a specialist (ortho dr).  I could not find what a hand ultrasound would cost.  I have no doubt it would be billed as two ultrasounds in the USA -right and left hand.  

When I priced the actual hand surgery in 2014 I was able to make several calls to billing depts in KC to get specifics.  I felt like I was close to actual costs as I had the CPT codes.  Trigger finger surgery in the USA in 2014 in KC would have been approx $10,000 US with no insurance.  Negotiated insurance rate is usually one third to one forth the uninsured price, so $3000 to $4000.  Of course this is only after deductable is met.  Our current insurance has a high deductable of $5,000 each.  Anything over routine annual test hits against the deductable first including ultrasounds, xrays, injections, surgeries , etc.... Those would be billed at the negotiated rate but still paid in full by us up to the deductable.  Then of course once the deductable is hit, some is fully reimbursed and other healthcare costs are a 60%-40% or 80%-20% reimbursement depending on procedure & plan. Trigger finger surgey in Trinidad in 2014 would have been $800 US plus some change for pain meds (cheap here) and follow up Dr visit so...$900'ish.  

And we wonder why our healthcare costs are so out of control in the USA.  Of course, I have had to do a bunch of research and digging to even get all of this.  Luckily, I had a job in the past where I could makes numerous phone calls, leave messages, wait on hold and take return calls to find out pricing and of course follow up in incorrect billing (more often that not by the way)  What of those that work a on a production line or in a mine or other where they don't have flexibility to makes calls during working hours?  

It is no wonder that our European friends shake their heads when it comes to US healthcare.  Many are afraid to cruise to the US for fear that something might happen physically and they will need emergency treatment and can't afford it.  Example - UK friends had another UK friend who broke his finger while cruising the east coast.  Simple finger fracture.  I don't know if he did a hospital or clinic but xrays were taken, he saw a doctor,  got a finger splint and then a bill for $5,000.  He nearly fainted.  Our friends said in UK the exact same would be $150 pounds.