Sunday, September 2, 2012

The $2,000 Wart

The $2,000 Wart

                                                                                                                                                                        We heard of $300,00 watches, or $100,000 fountain pens. Those are curios and usually become property of extravagantly rich people. But have you heard about  $2,000 wart? How much do you think is a wart's worth?

      Think of you and me, regular citizens of this country, people that earn their living by actually working. Suppose you want to get rid of a wart that appeared on your foot, in a sensitive spot, that causes you pain and preventing you from performing basic functions of life, like walking with a reasonable comfort. It is a small thing on your skin of the size of a particle of gravel that bites into your flesh at every step you make.
    After a short time, you begin to think that, maybe, it would be a good thing to get rid of it. You go to a doctor, a podiatrist, who specializes  with foot injuries and well being. Well, the diagnosis is - we need to treat it with a liquid Nitrogen. It is indeed a sensitive spot, and we cannot treat it (the wart) with other common method like salicylic patches or liquid wart removers, that do not work anyway.
    So the Nitrogen it is! Still a universal and widely used treatment for that purpose. Nothing peculiar or exotic. Just a liquefied gas that essentially destroys the tissue by freezing it. Nitrogen turns into liquid at -196C (-320F) and is usually stored at the elevated pressure.   The treatment consists of directing a tiny stream of liquefied gas at the exact spot of the lesion. Rapidly evaporating gas causes freezing of the targeted site. The application is painless at first, but later it feels like burns. The treatment is repeated every week or two. During this time the affected tissue surrounding the wart has the opportunity to heal, and the wart should get the signal of not being wanted. Eventually, the wart as an alien tissue, disappears. In layman's terms, this is what happens. Biologically, the process is, I'm sure, much more complicated, involving immunity and levels of pathogens, and some other difficult to understand processes.
      Thanks to the knowledgeable doctor (no physician's assistant), the wart in question was treated as it deserved. After two or three applications, however, it looked as if the wart did not get the proper signal and refused to instantly go away. At this point it was suggested that it should receive a "laser treatment" for its stubbornness.
      The question raised instantly was whether or not this new treatment will somehow improve the situation as to the number of sessions required for achieving the final effect. It seems that the only improvement would be in a "selective targeting of blood vessels" supplying the wart with nutrients.
      Question number two, of course, was who and how it would be paid for. So at this point the mode of treatment was to be determined by the way of financing the operation. Much to my surprise, the laser machine did not belong to the clinic, but to a separate business entity that specialized in renting it to the clinic for a fee. After some investigating, the company finally disclosed how much it will cost to bring it to the treatment site, allowing the doctor to use it. The fact was, that the cost was based on the number of blood vessels supplying the nutrients to the stubborn wart. It was getting quite an interesting endeavor to unravel the intricate ways to treat the wart and financial side to this enterprise. The people in this business are not very forthcoming with information of how much it costs to have a particular procedure performed. One cannot simply go to a clinic and see a price list, to consider, whether or not use this clinic, or go to the competition. Neither they have prices posted at the entrance to attract customers. The concept of "loss leader" procedure, the concept of introducing depressed prices, popular with retail outlets, would make the officials of a clinic die of laughter.
      And so, I decided to find out. The price for a treatment of a single blood vessel of a wart turns out to be $98 for about 1 minute of usage of the instrument ($5,880 per hour). There was a discount schedule for multiple vessels, but mine did not fall into the category of 5 or more. The stubborn wart had three of them, which would amount to $295 per about 2 min session. On the top of it, the clinic would bill for the visit, merely $200. Not counting the costs of transportation, one appointment would cost about $500. Now, the interesting thing is, that the laser company is issuing its own bill, of course, separately from the clinic.
      The health insurance company, upon contacting, had to make a special assessment and contact the clinic, as well as the secondary provider (the laser company), in order to issue an estimate of the treatment. It took about three weeks, before I learned that, yes, my insurance will cover it, but only 80% the "allowed" amount, in this case $57.91. Obviously I was responsible for paying the difference ($237.09) to the subcontractor. During this period I also learned that the insurance company couldn't find request forms for cost estimates for the secondary providers (in my case the laser company). The delays were explained to me as resulting from an unusual request for cost estimate of treatment. Evidently, not many "customers" make such requests.  After receiving the final estimate, the quick calculation revealed the advantage of using the Nitrogen. It took ten (10) sessions to make the wart make its mind and remove itself. The whole treatment cost was approx. $2100.
      That little thing that appears on your skin when you handle a toad! This is a treasure found by our health care system! Give us more warts they shout. No wonder, you think twice before going to a doctor's appointment. This is hardly believable, so we kept the documents and copies of them are posted with this story.
      This true account was inspired by a letter published in a local newspaper, calling for limiting costs of treatment by clinics, and written by a reader completely overwhelmed by $505 removal procedure of a tick.

      Have you got some other horror story to share with us?
                                    Hugh Harding for

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