Episode 219 | I’m Having Surgery: Pulling Back the Curtain – Part 2

What is up team and welcome back to another episode on the ACL Athlete Podcast. Today, we are continuing this series regarding “me” having surgery. The title is: I’m Having Surgery, Pulling Back the Curtain. Today is part two of this series and yeah, we’re just going to get into it. With part one, it talks about the journey leading up to knowing I needed this new procedure: hip resurfacing. Go back and listen to that episode if you haven’t yet, because it’ll help tee up this particular episode so you can understand some context and some background. Do that before you listen to this part two episode, which hopefully, helps to send a very clear message of my experience, as well as just some transparency, to be honest, throughout this process. 

It’s unique because I am a healthcare professional. I have had quite a number of injuries. I’ve had two ACL surgeries. I’ve gone through this process and understand it enough. But with healthcare and with medicine, it is just complicated. And the more and more time goes on, the more complicated it gets. I feel like it was just much simpler back in the day, whenever a deductible was $100 or $200, insurance covered what it needed to cover. Especially with the progression of technology and with just different healthcare systems and whatnot, it makes it a little muddy. What I want to do today is just pull back the curtain as I shared and just be super transparent about what I have gone through, and especially give you guys the full step-by-step of getting to this point.

To recap just a little bit, this has been a 12-year process in the making, essentially. I was feeling super limited, especially by my left hip for years and years, and it was getting worse over the past two years. I met with a surgeon here in Atlanta last year. It was the summer of 2024 to discuss my hip. He told me I was no longer a candidate for a hip arthroscopy, which is a scope procedure. They do a hip arthroscopy, and they go in and they repair the tears and reshape the bone, which is the issue that I have. It’s femoroacetabular impingement, which was something that has progressed into osteoarthritis as well (a moderate version of it). Honestly, it’s very rare for someone my age, being 33. I thought I was going to go into this consult with the imaging, and I was going to be able to do this hip arthroscopy procedure. But it turns out that wasn’t the option and that was eliminated, or at least the surgeon said, “Hey, this is not gonna be a good option, especially for your left hip.” What he proposed was a hip resurfacing for my left hip, which is a metal cap on my femur. Think about your ball and socket in your hip, the metal cap on there, and then a metal socket for my pelvis. Essentially, that creates a ball and socket with a metal component—a little different than a hip replacement. Main thing is where they cut off the femoral head and neck and they drill a hole into your femur (your long thigh bone) and they insert a big metal component component that is a big metal component that is anchored into that joint. Instead, what they do is they just shave off a little bit of my femoral head and then they drill a small hole in there, and then they plug in a metal cap like a metal cap for a tooth, if you can kind of think of it that way. So that would replace essentially my hip socket and my hip joint. 

This surgeon doesn’t do that procedure. He was like, let me refer you to somebody who knows about this, for the procedure. I was in the whole processing the next steps mindset. This leads into this next episode, really to give you the background of that. At this point, I was really in shock. I first ignored doing anything about it. I was just processing, especially because I’m so young and realizing this type of procedure doesn’t usually happen to someone like me. I am in a very, very small percentage of people where this has happened to—I mean, how many 33-year-old males that you know are getting some sort of hip replacement done essentially? This is something that even people in my community, physical therapists, friends, they’re not familiar with because it’s just such a rare situation. But it’s just something I’ve been dealing with. That was something that I was processing through after getting that information during the summer of last year. 

I started to realize how much my hip function had declined in the past one to two years. And especially now having a kid. It’s just interesting because I always tell people, especially in the past one to two years. I personally feel like I’m probably operating at maybe 20% of my capacity as a human to be able to be physically active. e I can go and play some sports here and there, but I pay for it. I’m almost a little bit careful with the way that I move. It’s not even anything to do with the ACLs, it’s more so just my hip. The other thing is just weightlifting, which I love to do. I love to lift weights. It’s my background. I love to push myself. And the thing is that I’ve just been so limited in being able to lift weights. I have to stick to machines most recently and reduce the range of motion, manipulating angles in my feet. I know all this stuff to do with this stuff, and so I just work within those limits. I can’t even sit on an upright stationary bike without my hip doing some wonky stuff, so I have to flare my feet out and my knees out, I’m not able to even cycle normally, to sit on a normal bike. I just started realizing how much I was limited in what I do and how much it influences my sedentaryness, if you will. I like to be active, I like to move, but I don’t want to get into this hip pain cycle. I almost avoid doing things and being on my feet as much and being active because I know I’ll pay for it. 

I started to really think about this, and I’m like, this is kind of gone, not in the right direction for a long time without me really noticing it. Now, having a business, also having a 1-year-old, layers into that with being busy and not prioritizing yourself all the time. It’s just had its challenges over the years, but I know that I’ve let myself really take a backseat with, especially, the physical activity side of things, and it’s something that I love. This is something that I started to truly reflect on. I think I was just in this denial period for some time.  Eventually, I came around to just thinking about this a little bit more and processing it, in terms of being able to do things that I want to be able to do and be a strong dad. I want to show my son that I’m strong, I can move, I can be athletic, I want to be able to move and lift for a long time. Being strong and being active is such a huge predictor of being able to live longer and getting the most out of the years as you live your life. That’s important to me, but especially just having my kid now, Asher, there’s just something about it that puts an extra fuel to the fire, because I wanna make sure I am physically there for him. Being able to play, run, kick the soccer ball, be able to coach his teams, be able to sprint and throw the football, jump, him watch me work out. There are just so many things that I know as a dad, I want to show an example of for my son and hopefully future kids, that this is so important to me as a core and a human being. I started to just think about my why, like why did I want to do this? 

And so then that got me into the place where I was like, all right, let’s do the thing. I started down the rabbit hole of research, and I want to talk you guys through how I specifically did it. Because I know a lot of people listening are exploring their own ACL process after they’ve injured it, or for the surgical process and the recovery overall. I’m going to share with you step-by-step what I did. Here’s how I went that route. The first thing I wanted to do was make sure that this was the correct route for me. That I didn’t have other options that existed. Was hip resurfacing the only option? Because in this space, there can be different opinions. I connected with multiple other providers, people who were world-renowned professionals in this space, to see what their take was on this specifically, because I was still in denial. But I was also like, okay, let’s see if some people are like, okay, I can do this. I had five different consultations with multiple providers; three of them were hip expert, physical therapist, one of those being a world renowned researcher for FAI and hip arthroscopy. And we talked through all of the details, not only my left hip but my right hip, because that one also has some problems. We talked through the different options. I also connected with two different hip arthroscopy surgeons who are also world-renowned, especially here in the U.S.. They’re really good surgeons, really good reputations. Got some good referrals, word of mouth, and did some research on them. 

I’m sharing this because I want the absolute best information to see what my true options were. While I trusted the initial surgeon I went to last year, I always believe in multiple opinions for any surgery, especially for complex cases, even for ACL. I tell y’all all the time, don’t just go to one person, go to two or three people, get some different opinions because bedside manner could be different, their approach can be different. Just because they walk into the room confident and tell you this is what happened and this is what you need, doesn’t mean that they have the answer. I promise you that, especially orthopedic surgeon community, how many timid orthopedic surgeons have you guys met? I’ve got zero. I’ve got zero on my list, and I met a lot of them. With that said, we need to make sure we do our due diligence. That’s where multiple opinions are helpful. I went into this, and I wanted to make sure that I just had the information that I was gaining in order to make sure I could make the best informed decision for myself.

The three hip PT experts and researchers all concluded that the hip didn’t look great. And I’d be looking at hip resurfacing as my best option. If I tried hip arthroscopy, I’d probably be really unhappy based on what the longitudinal data of the research looks like, as well as what people’s recoveries are with osteoarthritis. They said a hip resurfacing given my age and activity level would probably be the best option. I met with the surgeons, and then they said they wouldn’t operate on my hip. They were like, if you came to me, I’d say you need a hip resurfacing. It was due to a number of factors, but mostly the osteoarthritis played a big role in my hips, and said, let’s do hip resurfacing. They were like, Hey, I could refer you to X, Y, and Z. And so that plus the three hip PT experts, plus my local surgeon that I went to initially, it made it pretty clear the decision that hip arthroscopy was eliminated. I either option one, don’t do anything, or maybe I can get injections periodically, but that doesn’t resolve the limits of my range of motion, which is the biggest problem. Also, as this gets further and further along, there’s something that I’m probably going to need to do about it. Either that or just don’t do as much activity to not flare it up. 

Number two, get a hip resurfacing. 

Number three, get a hip replacement. I did not want to do anything. That wasn’t a solution for me because I’ve been doing that for quite some time, basically 12 years, and didn’t want a hip replacement when there seems to be a better option with hip resurfacing. I felt settled in knowing I needed to explore the hip resurfacing option next. I honestly didn’t know a ton about hip resurfacing until it was brought to my attention. It is not done nearly as much as an ACL reconstruction, knee replacement, or hip replacement because it’s this unique group of people who are typically between the ages of 30 to 60-ish. Now, there’s obviously like buffer room on the outside of that. But it’s between 30 to 60 that are probably the most common capturing groups, and it is people with hip arthritis that has progressed. They might have had some FAI or femoroacetabular impingement that progressed into our osteoarthritis, which is who I am. Maybe they had labral tears that had reconstructions that failed. Maybe they had hip dysplasia. Several factors play into it. Some people are just more prone to an osteoarthritis tendency, and usually, something is preexisting that exposes them to this. It’s a small group, though. Not a lot of people are dealing with osteoarthritis, especially in their 30s or 40s, yet. If it is, it’s very minimal, not to the level of being moderate. I know you guys are here for ACL, but I promise there’s going to be some parallels here. 

Given that I didn’t know a lot about this procedure about hip resurfacing, I educated myself about the procedure. What is the purpose of the procedure? What are the indications? What implants and materials were used? What are the outcomes? What’s the step-by-step surgery? What’s the recovery like? Once I got familiar with this, I researched the best hip resurfacing docs. And before I go any further, one of the things I’ve utilized a lot is, yes, I’ve used my network of people that I know and reached out to these people that I had consulted with. Of course, I did some Googling, but then I also used. AI a lot. I used ChatGPT, Perplexity, and I used these very solid research-based deep search functions, and I was able to get such deep dives and, of course, cross-referencing whatever the references were to make sure there was no bias associated with what I was asking.

But man, it was so helpful. If I’m being honest, Perplexity is awesome because you’re able to type in the question, and it has led to other questions with it. ChatGPT was also great, but I feel like deep research for Perplexity was super helpful. If you guys are looking for deep dives on stuff like this, it could be helpful to just give you some cliff notes, and you can ask it to dumb it down for you or get more detail about this. Ask a follow up question. We need to embrace the technology, and it’s super helpful because. Even for me, knowing this world and knowing a lot about it, it was still so informative for me because that thing is so smart, and then you can just kind of cross reference some of that information across other information, things that you gather from other education and resources, and make yourself well-informed. And that was my goal: how can I make a very well-informed decision about my care? 

I started with the education piece and started to figure out, okay, what can I do with all this? So that’s how I started with that, and then started researching the best hip resurfacing docs to do this procedure, and researching these hip resurfacing docs was interesting. It’s a very big difference in ACL reconstruction versus hip resurfacing, if I’m being honest here. With ACL, there are tons of surgeons who do this, and you’ll find any big metro city. There’s gonna be a go-to surgeon or multiple ones who do them? Here in Atlanta, I can name five, six of them who do ACLs all the time, and different outcomes, different graft types, different ways of going about it. But the thing is, there’s a ton here in Atlanta who do it. Any major city, because we’ve had people all over the world, all over the U.S., surgeons are doing these things. I’m talking about they’re doing at least 5 to 10 ACLs a week, for example, which is a pretty decent number here. Of course, some surgeons do 5 to 10 ACLs a year. Don’t pick those. That’s not enough experience for a procedure that is going to change the actual anatomy of your body. I don’t care if it’s in your network. I don’t care if it is just convenient because it’s five minutes down the road. Find the best person that you dive with, that listens to you, and that has the volume because that’s going to be super important. If you can make sure to ask them the questions, we have an eight-question PDF that you can download at our resources section on the website. I have a podcast I’ve done about asking surgeons your top questions, to make sure you vet them, and that way you also know how many they are doing a week.

I went through this process with these surgeons, but the thing that’s interesting about the hip resurfacings that I mentioned, there’s not just a ton of those in every city. Even here in Atlanta, yes, there’s hip resurfacing surgeons or hip surgeons, but they might do a ton of total hips, and then they might do just 5 to 10 hip resurfacings a year. Guess what, not going to happen for me, I promise you that, especially for someone who’s going to be putting metal into my hip. This is going to be someone that I’m going to trust. They have the numbers and they have the outcomes that I’m looking for. I’m looking for that equivalent of 5 to 10 a week, at least for me, for example, with solid results. This is where I started digging in deeper. Guess what y’all, I joined a Facebook group. I know I give you guys some grief on this sometimes, but look, I get it. It’s a double-edged sword, and you’re trying to get information. And I know that Facebook groups and Reddit are places that people go. We’ve had people we work with who have come straight to us from those places, and I get why. I knew this even before I was exploring these procedures. I’ve been in these groups, and I get tagged in stuff, and I get why, man. People want to understand what other people’s experiences are, have comparisons, feel normal, and just be able to consolidate information.

The challenging thing is that people with not a lot of experience who are sharing their thoughts, this is the best, this is the go-to, this is the best graft, this is the place to go to. And it’s great, typically, it’s an n=1. At the end of the day, we don’t make decisions on n=1, we make decisions on n=1000, 2000, 3000, 5,000, 10,000. And that’s where research and data is so helpful. We are not going to make decisions off on just one person’s anecdotal experience. Because they could have a great experience and then there could be tons of other people who have terrible experiences, but you’re only seeing one person’s good experience. So that’s where we have to be careful. I get through that people want other people’s take on things, and it was helpful for me to go through this process very freshly of seeing people who are talking about this hip resurfacing and their experiences, and it’s a very active group. They’re talking about how they’re doing five days post-op, what kind of implant they got, and who their surgeon is. And I read through a lot and talked to different people and their experiences with different surgeons and different implants. It is just interesting that, yeah, I went the Facebook route just to get some information from an anecdotal experience. I think this is not something necessarily bad. I think that we just have to filter this very carefully, especially because I know I’m coming from a place, being a medical provider, being familiar in this space, I can filter things a little differently of what people are saying and experiencing versus being the end all be all. I think that’s important to make sure I share here with this information. But I know that it could be helpful. It also creates a community, which is super helpful, and I’m all for it as long as we just don’t take it to extremes. 

With all this information as I was gathering, some consistent surgeons were seeing with this. I had shared that there are only certain surgeons who do this well, this procedure. And I finally had a list of two specific ones. I was going to look at it after hearing consistent positive outcomes from people and then researching these surgeons on my own. These were the two go-to in the entire U.S. and the world for doing this procedure. Now other countries have a surgeon here or there, but within the U.S., I’m going to stay here. And this was my focus was to find one of these two to do the surgery. I started with one and consulted that surgeon because they were a long drive away versus one I had to fly to. It was a little more complicated, especially from Atlanta. I started with the closest one, and he took the time to look through my imaging, look at my story, and hear my story, and let me share where I’m at with things and the goals that I have. And he asked me about these things, and he shared the general game plan with me.

I asked a lot of questions and he answered every single one of those questions. He didn’t dodge one. He didn’t just try to move on or rush me. It was honestly a very great experience from a consultation standpoint. I asked him how often he does it, the risks associated, his testing process, survivorship of the implants, and recovery protocol. I even asked him some pretty hard questions about some details from his research, and he took it on head first and he also told me things that he was like, I don’t know. And I respected that so freaking much. But the fact that he answered my questions, took the time, I was like, you know what, this is a solid experience. I, of course, researched his outcomes of implants and anything you possibly could imagine, even before this meeting, but I wanted to hear some of this stuff from him. And you guys might think I’m crazy, but y’all, this isn’t just fixing a part of your house, like painting the walls or replacing the roof or maybe even just some broken bone where they need to cast it up. It’s a specialized surgery that can make or break the quality of my life, for better or for worse. I’m saying this in parallel to ACL rehab and the surgery itself, too, is that do your due diligence. Because I’ve worked with so many people who have just got caught up with the wrong surgeon. They didn’t necessarily answer questions or ask questions. The surgeon just came in, walked in, this is what we’re doing. They might’ve gotten one person who said, Go see this person. They didn’t get multiple opinions. They’re like, okay, cool. This is in my insurance, or this works, and then they do the procedure, and then they end up regretting it because they didn’t do deeper research on the surgeon, or the graft type, or what their return to sport process was, even if there was one testing process. There’s just so much, and it influenced the quality of their life drastically, whether it was months, years. I’ve seen people 10 years out who they were just like, man, I wish I could have just chosen a different surgeon. This is why I’m stressing this importance to you guys, because it’s important to me, it’s important to your life. You only get to do this once hopefully, and so do it right. That’s why I’m doing this research, especially for such a unique procedure for this category that I’m in. But even for ACL, this is no different. And the beauty is that some options are probably more available. But with that said, it makes it more confusing, and I get that. So then that’s where making sure to vet these professionals who are on your team is so freaking important. I am practicing what I preach, and that is so important to me, and that’s why I’m sharing it with you guys. I learned a long time ago that we have to be our advocates as I’ve gone through this process. Otherwise, you’re just going to be funneled along like a part on a conveyor belt. I was like, I’m not doing this this freaking time. I was like, I know better and now I’m going to do better. This is me going through that process. 

Next, what I did after the surgeon’s meeting, I did a deep dive into the different implants and procedures. I did super deep comparisons, used AI research again, I went into different research studies. And there are a few ones out there. It’s something that I was like, oh, parallel to ACL. Sound familiar, maybe picking ACL graft types. I had to understand the pros and cons of each type. There are some risks associated. I finally landed on the one that I felt, and my gut was right. After the conversations and making sure I did my due diligence, I also talked to the surgeon a little bit more. And this was his specialty. I was like, okay, let’s do this. 

Next was the insurance battle. And during this whole time, I’ve been working through that, especially coming into the year 2025. I knew that this was something I was potentially going to do, but I wasn’t sure. Honestly, as I shared in the previous episode, probably been the biggest influencer of my hangups of being able to tackle this earlier. It’s interesting if I could just be transparent with you guys that if our insurance healthcare system was better, if it didn’t cost us so much, I would’ve had this probably taken care of whenever it was bothering me back in 2016 and 2017, even maybe after 2018, 2019. But my insurance has been so awful, ever since I have been alive, to be honest. Maybe when I was a little kid, it was good. But I know that ever since I left for college, I’ve never had a good insurance plan—never in my life. I’ve had such expensive insurance, high deductibles, and high out-of-pocket maxes. Especially when you’re a broke college student and a broke PT student and then you’re a new grad tackling this debt and you’re gung-ho about your career. The last thing you want to do is go and have a procedure done. You just ignored it. It wasn’t enough of a big deal for me to go and do that. But it’s crazy when I look back on this, because every single year I’ve had moments where I’m like, maybe I should go get this checked out, but I’m like, uh, I gotta deal with insurance, find someone I trust. Deep in this process of building a business or in my work that I was like, I don’t know. Insurance was the biggest obstacle, because I know that if insurance wasn’t, then I would have jumped on getting this tackled sooner. It’s just crazy for me to reflect on this, that because of the design of this, and I know so many of you probably feel this. But because of the design of this system is the reason why there was just such a delay. 

Now, this might be  a cop-out you guys think, because it’s like, oh, well you could have went and done that. But if I’m being transparent, it just is what it is. That played such a big role and why I decided not to evaluate this earlier until I got to this point. The timing of this was super important coming into this hip procedure because as a small business owner and my wife working for a small nonprofit as a special needs teacher, we don’t have great options. We haven’t had great options since we’ve been married. We haven’t had a great options over the past four or five plus years. A lot of these options just covered the state of Georgia as well, especially as we were evaluating these things. Going out of state typically, “out network” is challenging because usually good insurance is reserved for companies who are bigger. If you work at a big company, typically there are these deals made with insurance companies where, oh, okay, like you have 500 people, 1,000 people, and then you start thinking about these tech companies that have thousands and thousands of hundred thousands of people that work for them. Guess what? They get better deals, which means the employees get better insurance, better rates. Companies usually pay a decent portion of this stuff. When you’re a small business owner, you’re just left to find what you can, right. And I know this doesn’t apply across international and I know there’s socialized medicine, I know there’s private pay insurance as well. We’ve worked with people for all over, so I’m familiar with the landscape of a lot of different healthcare insurance systems and socialized medicine systems. It is just interesting, I literally had someone message me and share a comment and they were like, I paid $360 for any medical costs. After that, my government covers anything and they had surgery in four weeks for their ACL. I was like, wow, that’d be super nice. But guess what? We’re in the U.S. and it’s a business. And so this has just been super interesting to be able to navigate. And so with me being this business owner, my wife, working in small nonprofit and not really having out of state help. And the thing that was challenging is that this surgeon was out of state. 

As we came into the new year, I spent so much time evaluating our insurance options, our coverage, our costs, etc. All them sucked. You’re just like, all right, pick the least suckiest one, if you will. One thing that I did prior to this, I actually asked the surgeon for the cash rate for the procedure out the door. And that’s something that can be common here in the States, because if people have high deductible plans, then a lot of times they’ll just be like, Hey, what’s your cash rate? Because you’ll never meet it, especially if you’re a generally healthy person and you’re going doing normal medical stuff. And then sometimes you might just be like, all right, I’ll just pay the cash rate and not file it to my insurance. I asked the surgeon for the cash rate $29,000 for my left hip. I was like, I might as well use the insurance if I’m going to pay that much. Here’s where I’m going to share what we landed on. And I’m going to give you the numbers all full in detail. I hope you guys are ready. Don’t let your jaw drop too much.

As a generally healthy guy, I don’t really have any issues. I know I got this hip thing going on, but I don’t really have any issues. My wife being healthy overall. Our son at the time, being nine months old at the start of the year. Here was our best option and we considered a lot of them. We had to split my son and put him on a different plan, and me and my wife on a plan together. And my son’s plan per month is $320 per month, his deductible. Deductible is essentially the amount you have to pay yourself before your insurance starts to help you out at all. Now, there are certain things like a general health exam or checkup or maybe basic blood work that’s covered without having to meet your deductible. Or sometimes there’s a co-pay. Maybe you pay $20, $50, $100, or maybe there’s a co-insurance involved. Usually a co-insurance is, Hey, you pay 20% of this bill, the insurance pays 80% of this bill. With his deductible it’s 1500, and then his out-of-pocket max is 5,000. Basically, if he were to have something done outside of basic stuff, we would need to meet $1,500 total. And then after that, there’s an out-of-pocket max of 5,000. His plan would cover 80% of charges up to 5,000, and then we would be responsible for 20% of that. Therefore that would be 3,500 essentially left where we would need to fill up 3,500 in order for them to start paying 100%. That is usually something when there’s a bigger medical cost, like a surgery or multiple days in the hospital. Sometimes people with ongoing disabilities and things of that nature have to usually meet this. And so that’s where we’re hoping this at least like covers him. And if anything goes south, at least we have a certain amount that we know will hit and then we’ll get a hundred percent coverage after hitting 5,000. And that’s only with in-network providers, not out network. 

In-network means basically there’s a contract with the insurance, and out-of-network means there’s no contract and sometimes there’s no coverage with those out-of-network providers. If you have a certain type of insurance, a PPO, then it can cross over. All that to say we pay 320 a month for him. And then that’s his deductible and out-of-pocket max, for me and Abigail. Drum roll please 1100 per month. Our individual deductible is $6,000. Yep, 6,000. Our individual out of pocket max is 8,500. Basically, I have to pay up to $6,000 before anything really gets to start getting any coverage. And then out-of-pocket max 8,500 for in-network. Once I hit $8,500,  the insurance will pay a hundred percent for everything else. Our family deductible. So this is just for me and abs because we’re on separate plans. This is $17,000 and for our family deductible is $12,000 and for our family, out-of-pocket max is $17,000. So that basically means if we hit our family deductible, then our co-insurance kicks in and we have a 70/30 split. So 30% we pay, 70%, the insurance pays up until we hit 17,000. Then as a family, if we spend $17,000, then the insurance will pay a 100%. Real cool. $17,000 in medical expenses. That was all for in-network. 

Now, here’s for out of network. Now we were able to find a plan at least that covered some out of network, but it’s crazy. It’s basically like not really covering it. Individual out of network deductible is $12,000. Before they cover anything for out of network, you have to spend $12,000 for an insurance to even touch anything, even 30% coverage. And then once that 30/70 split kicks in after 12k, guess what? It’s a 25K out of pocket pocket max. So basically to give you guys a good reference here, and also these don’t cross over. The 8,500 for the deductible or the out-of-pocket max doesn’t cross over and just work for the 20 5K for the out network. Basically, two different paths and you can choose which one you want to go to. Maybe one person is on one path, one person is on the other. But that’s essentially how it is.

We pay $1,420 a month for insurance for my family. I’m just going to pause there for a second, just for a moment of silence, and we basically have to hit 1500 for my son and 6k for either myself or Abigail, for us to get any true coverage outside of the general basic coverage like a health exam, some basic blood work. That’s about it y’all. Otherwise we gotta pay 1500 or 6k depending on the person for insurance to even start helping us out. The cost for the out of state for this surgeon is $6,000. He does not accept the insurance we have. He is an out-of-network provider. So that 12,000 out-of-network deductible I talked to you guys about, that’s where this 6,000 is going to go.

And guess what? I’m only 50% there with this outta network cost. So guess who’s responsible for that amount? Yours truly, the cost of the surgery center and the anesthesia and just the, the way that they bill this. to give you guys an idea, um, I had the billing insurance lady send me the details because I was like, I am not going to accept anything until I see itemized bill.

And their itemized bill bills are laughable. Um, but anyways, with that said, they sent it to me and here is the breakdown. They gave me the CPT codes of two different things. They gave me the descriptions of each, and then they gave me the build charges. So this is what the system is going, the surgery center is going to bill them.

This is not even actually including the anesthesia. We don’t even know what that looks like yet, but this is the surgery center alone. The first CPT code for this procedure is $34,436 is the bill charges that this surgery center is going to send the insurance, and then the expected reimbursement there they’re expecting to get back is $18,000.

So here what happens is that it’s just kind of this game of kind of Russian roulette, if you will. Um, a lot of this stuff is based on the, uh, the Medicare bases, a lot of rates. And so then other insurance companies will kind of dictate things based on their rates. There’s a lot of back and forth negotiating contracts, all this stuff.

They inflate the charges because they want to get as much. Out of the contractor rate is possible, right? So they’re hoping if they bump up the build rate, that the reimbursement will be higher, right? So that’s just more money for the companies, more money for the surgeon, the surgical facility. And this is just across the board.

This is how it works. And then in terms of the implant itself, it was 61 40, so $6,140, and that’s essentially how much they expect to get reimbursed. And so all in all, you know, they are billing for almost $40,000, but this doesn’t include anesthesia, and it doesn’t include the surgeon’s expenses either.

So if I had to guess, we’re probably talking like a 50, $60,000 procedure. All, all, all things considered that are built Now, uh, the only fortunate thing about this, if you want to call, call it fortunate, is that the. The surgery center and the anesthesia is quote unquote in network. So that’s the thing that, you know, is gonna kind of save me here with these costs a little bit.

but it’s just kind of depending on how you look at it. but as I had shared here, what I’m looking at from the itemized bill, which is those two CPT codes, that’s gonna be a total of roughly like 40,500. And their expected reimbursement of that is gonna be roughly about. 24,000. So you know, they’re trying to get Bill 40, 40,000, a little bit above that from what I see from the surgery center.

And then they’re trying to get back 24,000 of that, and that’s what their expected reimbursement rate is. For me to give you guys perspective on this, with the insurance, it’s basically gonna cost me 8,500 because they’re in network. As I had shared the surgery center itself, this is different from that surgeon fee that was $6,000.

That will go to my 12K out of network deductible. So. All in all six K to the surgeon, 8,500 to the surgery center. that’s just because it’s going to end up hitting my out-of-pocket maximum for my deductible and for, the in-network charges, if you will. So then therefore I’m gonna max that thing out, and then after I hit 8,500, my insurance is gonna pay a hundred percent of whatever is left.

So that. You know, 24,000 that I shared, I’ll basically pay 8,500 of that and then the insurance is on the line for the rest of it. And so to all in all from my end, what I’m looking at is 14,500 so far. So all I’m paying right now is that total. I say all, and while you think that’s a bargain compared to the, you know, 50, 60 K that’s billed, it’s just wild to think that that is like, okay, or this is a discount or this is good in reality, this is just bizarre for just a general just health procedure y’all, that a basic human need.

Right. Um, to live life, right? And so it’s crazy, but let me kind of make this a little bit more real for y’all. That’s 14,500 and then 17,000 for our monthly premiums for our family this year. So all in all, $31,000 500 on this procedure and basically medical coverage for my family. Now I’m gonna give that a moment of silence.

It’s crazy, and this is assuming my family needs nothing else. They don’t need to have some sort of medical procedure done. They don’t need to have testing done. Even just a basic like, Hey, you need to go get x-ray on this, or Hey, you need to go get extra blood work on this. You know, that’s gonna cost us, it’s not.

Basic healthcare, it’s additional, right? When we go to see a specialist, for example, it’s a hundred bucks for a copay. Um, for my son, it’s $20 to go see even just the primary care provider. So every time we walk into the office, $20, $20, $20. Every time you get sick. $20. $20. And guess what? Kids get sick, y’all.

And you’re gonna take them in more than you think, because you want to make sure that they’re okay and you’re a new parent, you don’t know what’s going on. So that stuff adds up too. And so what’s sad in all this? Is I may be considering my other side, which will cost me another 6,000. Luckily, the 8,500 has been covered for the in network.

So you know, if I have this procedure again, I won’t be having to front that. Um, but the six K will be something I’ll have to pay the surgeon fee for because he doesn’t take my insurance and this is if my insurance approves it. You know, there’s always a chance for it to get rejected, um, or unapproved. Um, so then therefore that would be a problem and I have to do it before the end of this year.

So isn’t that kind of crazy with all this considered that this is how this kind of all works out And what’s most important here is like, what’s wrong with this? And I just want to kind of just pause here for a second just ’cause it’s like, how is this possible? The US healthcare system and the insurance is awful, y’all.

It’s terrible. And I’m like, I’m in a place where I’m educated. I understand this stuff better than most people. I do deep dives on understanding this stuff. It’s why we honestly don’t work with insurance as a practice and working with people is because it just is so frustrating because we want to give you value and service outside of someone else dictating the care.

You get to control it. We get to control it. So we eliminate this middle person who is a for-profit business, and that is where it has gotten us into trouble is because it’s this constant. Business. Let’s make more money, more profits. If y’all looked up how much that these CEOs for these top insurance companies make, your jaw would drop, and the amount of profit that these companies makes.

We’re talking about billions of dollars Y’all. It’s so much money and all they do is milk a system and milk the consumers. And the thing is, is that the government isn’t helping us as much as they can with this. And it is just so challenging and it makes me really, really sad for our healthcare system and the amount of.

Chaos that is provided and just like how sad it is for a lot of people going through this and I get it look like y’all, like one thing that’s good about medicine is it’s great at keeping us alive and being able to do really cool stuff that’s innovative, but. In terms of being proactive and helping just basic human needs, it just doesn’t, it just doesn’t do it.

And so I truly think that something else needs to happen. Something needs to change. I think that insurance systems need to go away, and I think that there needs to be a competitive market where you can just be in network with people. I think that there needs to be more players in the game, which will diversify the field and then therefore make the costs more competitive.

I also think there needs to just be more transparency. Like if I get a bill, I need to know exactly what those costs are and why. I know we get explanation of benefits, but like. Those things are so vague sometimes. Um, so it is just kind of crazy to me, and I won’t even spare you guys the amount of time my wife and I have spent over the years on the phone just talking to insurance companies, to agents, people who have just, you know, build things wrong, did insurance stuff wrong.

They were like, oh, oops. And it could be like a $5,000 bill that changed into like a $200 bill. Y’all. And if we didn’t look at that, we’d just be on the line or they’re like, Hey, this is going to collections. And it’s like, no, like you didn’t build this right. And it is just crazy to me. And so I’m sorry. I know I’m like belaboring this point here, but I know a lot of you feel me here.

And it is just something that just really hurts my heart for our healthcare system and. Where we’re at at this current point, and this is me being able to, you know, pull outta savings and being able to do some of this stuff, fortunately, but I think about other people who are just less fortunate. It’s like, what?

What are they gonna do, man? And you know what, that’s why. Even though we spend the most as a country, we are not the healthiest country. It’s because we have a very bad system and there just needs to be something that changes in order for us to make it to the top of having a healthier society. And then also being able to somehow bring these healthcare costs down.

And I think the biggest thing is transparency in healthcare. being able to also eliminate insurance somehow. The solution to that, I’m not sure, but I think eliminating it. And in my personal opinion, I think it should be no different than car insurance. I think for basic health insurance stuff, like we don’t need to expect health insurance to cover everything, but maybe for, you know, an oil change.

Your car insurance isn’t covering that for, you know, your tires to get changed. It’s not being covered, and I think that’s the best way the system is going to operate. It makes way more people competitive, therefore the rates won’t skyrocket and therefore, you know, when you get in a big car accident, guess what?

Insurance kicks in and it helps you. Same thing here. I think that’s how our healthcare insurance at least, could be better operated. Now, I don’t have the solution for everything, different socioeconomic status, all these things that are such layers to this, but I know the biggest thing about it is money and it’s profit, and it’s just the government and insurance associated companies that are just.

Kind of in cahoots together. They’re just like, cool. Like if they’re getting the money from the taxes, then like, let’s keep rolling with this, right? So it’s just a lot of layers to this, and I know I’m on this long tangent at this point, but it’s just something that is just really troubling and I wanted to share some transparency on the numbers for this procedure for myself as well as what my family is dealing with.

And this is probably the average American family to some degree. And so this is just kind of crazy. And my brother, who, uh, works for a corporate company, he pays little pennies compared to what we pay. Um, and it’s because he works for a big company, right? And so then therefore, you know, he has great health insurance.

He has, uh, very little to pay from a premium standpoint. And so that’s great for the bigger companies. But then what about us little people who are trying to do something different? I’m just, you know, it’s kind of crazy for there to not be other options that are just as equivalent, you know? And so there we are with my insurance rant and complaint, but I just wanted to share that with you guys.

And the last thing I’ll share that with this is that the billing lady who asked me to pay for this amount initially, it was like about a month ago, she billed me actually 1400 saying the insurance will cover the rest. And so I was like, okay. I was like. All right, we’re not bad here. I’m guessing that maybe like the surgery center doesn’t bill a ton, and so I was like, maybe this procedure doesn’t cost that much.

So I was like, 1400. Cool. And then three weeks later, she like calls me multiple times and she emails me, or she doesn’t email me. She just calls me and she’s like, Hey, um, I’m, I’m here to pick up the amount we were able to reduce from 8,500 to 7,300. And I was like, wait, I got an email from you saying it was 1400.

And she was like. No. And so then she went back and looked and she got the wrong number. So my cost went from 1400 to 7,300 because I had met some of my deductible already. So instead of 8,500, I’ve already paid some of that. So I had 7,300 left. That’s not even including the 6,000 for the surgeon. And so the craziest thing with this is that I just got sent a link as well, and it was just like, Hey, pay this.

And so, um, I’ve gotten tons of bills over the years, especially with this thing coming up and it’s just payment links, no amount, no amount of detail to why it’s, for this particular thing, no itemized bill. I would almost equate it to, you know, you take your car to the mechanic. And you have a lot of stuff done to it, and then they just give you this just general, you know, here’s, you know, $2,000, but they don’t really give you an amount or they don’t give you the detail of what was done in it.

They’re just giving you like, Hey, it’s 2000. So then you have to go through and dig through and be like, all right, well, tell me how much this was, how much this was. Like, why was this labor this much? You know? And but the thing is like usually they provide all those itemized bills and costs. And so with this, like you have to dig deep to get that stuff.

You can’t just get it flat out, it’s just payment links, pay this amount, otherwise it’s going to collections. So I looked up the coding to all this stuff, made sure it lined up sadly, ’cause I’m meeting my out-of-pocket maximum. Anyways, I decided not to really dispute any of this. Um, even though there were differences in the amount of upcharge they did, it didn’t matter ’cause I was gonna have to pay 8,501 way or another.

But if I was someone who only had to pay 4,000 because it is a lesser procedure and I had a 8,500 out of pocket max, I would’ve fought this because they’re just upcharging the crap outta things. And so this is just something I was like, it’s not even worth the fight. Um, and then to wrap this thing up, because it’s already been way too long, I hired a coach.

So I tell you guys that it’s important to have a guide. It’s important to have someone that is an expert. It’s important to have a plan. It’s important to have a roadmap, and it’s important to have testing. Well, guess what? I hired somebody. While I could have tackled this myself, I’m knowledgeable enough to be able to handle and do this.

I didn’t want to. And I wanted to make sure that I had someone who knew this procedure, who has walked people through it, who can talk me off a ledge sometimes if I’m in my brain, who can just kind of do the programming for me. Give me the roadmap, give me the guidance, be there for me when I want to ask questions, and guess what?

It’s been awesome. And that is something that I want to practice why I preach, which is why I did this. So I hired my own remote coach, and so if you’re listening here guys, like I’m not above this, just even because I know this space, like there’s so much value out of getting someone else to do this for you because they can look at it objectively.

They can help you along in this process, and especially if they’re experts in this space and know what they’re doing. So. For your ACL rehab, find an expert to help guide you because guys, it’s been a huge game changer to have him along my side and to just not worry about things as much, and him checking in and being able to talk like it’s been awesome and my progress has been awesome.

And so then therefore. I just wanted to share this with you guys as I wrap up this podcast series, wanting to pull back the curtain a little bit and be as transparent as I could be, step by step. My journey, and I’m doing this for myself, I’m doing it for my family, I’m doing it for my son, for hopefully future kids like.

I’m doing it for them. I’m doing it for myself, and it’s important to me, and it’s important that I share this with you guys. So I love you guys. I know that’s a lot to say to people I’ve never met, but I really do. I love this community. I love the support, I love the messages that I’ve gotten, and I promise we will get back on continued ACL.

Education and info. I’ve got a lot of stuff lined up that’s gonna be super fun. But I hope that this was helpful, y’all, for those of you who stuck with me, hopefully you did it on two x ’cause I rambled a lot, but. Just wanted to share this. I think it’s so important, and as myself walking through this, having my two acls, having this hip resurfacing, I think it’s important.

I just wanted to bring that to you guys, and I hope that you got something out of it. That’s going to do it for today, y’all. Until next time, this is your host, Ravi Patel, signing off.