Continue or stop diving with a PFO?

[ginti]

I have also a reasonable explanation for this, based on the fact that for long deco dives the commanding tissues are the slow ones, which have less interaction with the presence of a PFO.

I don't understand why fast tissues interact with the presence of a PFO... could you explain the mechanisms you have in mind?

 

[tridacna]

Medical and dental tourism is not unusual. @DandyDon is a regular traveler to Mexico for this purpose.

People are free to travel wherever for cheaper medical procedures whenever - I just don’t get the EU or Europe thing that people are talking about. If you don’t contribute (through taxes or directly with premiums), not too many countries will welcome you for discounted socialised ELECTIVE treatment.

 

[ginti]

People are free to travel wherever for cheaper medical procedures whenever - I just don’t get the EU or Europe thing that people are talking about. If you don’t contribute (through taxes or directly with premiums), not too many countries will welcome you for discounted socialised ELECTIVE treatment.

Indeed they will not.

The points are:
- similar healthcare systems (including education), meaning that doctors will provide similar services (similar is not "the same"); insurance isn't common since the most basic services are covered (some people in this post discussed insurance issues)
- price should, in theory, be relatively aligned among different countries (cheaper than the US)
- travel is simple (besides pandemic)

 

[DandyDon]

Medical and dental tourism is not unusual. @DandyDon is a regular traveler to Mexico for this purpose.

Oh, that's a bit of an exaggeration perhaps. I got my first and second set of dentures in Cancun and saved enough to pay for the dive trips probably altho I am not sure as I couldn't get straight answers from local dentist offices on costs. I get them cleaned in Cozumel every year for very little, much cheaper than teeth cleaning here, but when I didn't travel last year - none of the few local dentist offices would even do that nor replace a lost tooth which I also accomplished in Cozumel for very little, very easily.

I was making the trips anyway tho. I don't know that I would have flown down just for dentures, much less cleanings. For major procedures like root canals, it might be worth it, but I'd have to check again. I think that my daughter got hers done locally even tho travel to Cancun would have been cheaper overall as she didn't want to bother with travel at the time and she really likes her local dentist and office.

People are free to travel wherever for cheaper medical procedures whenever - I just don’t get the EU or Europe thing that people are talking about. If you don’t contribute (through taxes or directly with premiums), not too many countries will welcome you for discounted socialised ELECTIVE treatment.

I'm sure that they wouldn't, but there are lots of possible differences...

• I guess that there are doctors and services even in countries with socialized medicine who also do procedures for cash payments.
• Those doctors and services even in countries with socialized medicine probably save many thousands of dollars by not paying for insurance at US rates caused by the US courts and sue system.
• And perhaps doctors in those countries don't enjoy the major incomes as compared to the rest of the country as in the US, but that's a guess.

I did not read all five pages, but from post #1 - if I were in his position, I'd try the appeals process. A quarter of the population has and lives with PFOs including a quarter of divers without problems usually. If I had one that did cause problems of any kind, I'd want it fixed and be fighting mad if my medical coverage wouldn't fund it.

 

[tridacna]

Oh, that's a bit of an exaggeration perhaps. I got my first and second set of dentures in Cancun and saved enough to pay for the dive trips probably altho I am not sure as I couldn't get straight answers from local dentist offices on costs. I get them cleaned in Cozumel every year for very little, much cheaper than teeth cleaning here, but when I didn't travel last year - none of the few local dentist offices would even do that nor replace a lost tooth which I also accomplished in Cozumel for very little, very easily.

I was making the trips anyway tho. I don't know that I would have flown down just for dentures, much less cleanings. For major procedures like root canals, it might be worth it, but I'd have to check again. I think that my daughter got hers done locally even tho travel to Cancun would have been cheaper overall as she didn't want to bother with travel at the time and she really likes her local dentist and office.

I'm sure that they wouldn't, but there are lots of possible differences...

• I guess that there are doctors and services even in countries with socialized medicine who also do procedures for cash payments.
• Those doctors and services even in countries with socialized medicine probably save many thousands of dollars by not paying for insurance at US rates caused by the US courts and sue system.
• And perhaps doctors in those countries don't enjoy the major incomes as compared to the rest of the country as in the US, but that's a guess.

I did not read all five pages, but from post #1 - if I were in his position, I'd try the appeals process. A quarter of the population has and lives with PFOs including a quarter of divers without problems usually. If I had one that did cause problems of any kind, I'd want it fixed and be fighting mad if my medical coverage wouldn't fund it.

There is no “appeals” process for elective non-vital surgery. The OP stated there is a backlog for this surgery in Norway anyway. Bottom line is that the OP will probably have to pay for the procedure out of pocket if he wants to safely continue diving.

 

[ginti]

I'm sure that they wouldn't, but there are lots of possible differences...

• I guess that there are doctors and services even in countries with socialized medicine who also do procedures for cash payments.
• Those doctors and services even in countries with socialized medicine probably save many thousands of dollars by not paying for insurance at US rates caused by the US courts and sue system.
• And perhaps doctors in those countries don't enjoy the major incomes as compared to the rest of the country as in the US, but that's a guess.

The first point is true, and I assumed it was clear to everyone, but maybe it isn't the case.
The second one is possibly true, which would explain why the prices were mentioned looked so crazy for me (but, me not being a doctor, I might be wrong on the prices).
The third one is partially true - private doctors can make tons of money, but they aren't the average; in general, wealth is better distributed in Europe than in the US, meaning that more people live "well", but fewer are really rich. In other words, an average doctor makes more money than an average person without any specialization, but they aren't rich.

 

[DandyDon]

There is no “appeals” process for elective non-vital surgery.

Then my statement would be the case. I wonder if public support and political pressure would help?

If I had one that did cause problems of any kind, I'd want it fixed and be fighting mad if my medical coverage wouldn't fund it.

 

[boulderjohn]

List price in the US is based on a feedback loop of insurance underpaying and providers jacking up the price in attempt to get insurance to pay more.

I won’t lie, when I looked at what my insurance was charged, it was insane.

The fact that your insurance was billed that much does not mean it paid that much--not even close.

I was in an accident that led to significant surgery, with my insurance company being sent a huge bill. I had to pay a pretty big copay for it all. I sued the person who caused the accident, and my attorney told me the insurance company would ask to be reimbursed for its costs from the settlement. I said that if the insurance company got all that money back and the attorney took 33%, it looked like I would end up losing money if I won the suit.

He explained that the insurance company does not actually pay as much as they are billed. He said under the law, I could sue for the full charges of the medical care, and I would make a profit from the difference between those full charges and the actual amount the insurance paid.

Well, I did win the suit, and when it was over, the insurance company was entitled to recover their actual costs. Their actual costs were zero! That's right, my entire medical costs were actually covered by my copay, so they hadn't paid a dime.

The reason for the sky high charges to the insurance company is to get your copay up high enough so that you actually pay for everything instead of the insurance company.

 

[ginti]

Then my statement would be the case. I wonder if public support and political pressure would help?

It is actually a bit complicated. Technically speaking, the healthcare systems cover some (several?) non-vital surgeries, but these are often regulated and are usually related to issues that affect the quality of "daily" life.

The PFO of the OP affects only his diving activities, not his *daily* life, so I doubt it can be covered, but never say never...

 

[rddvet]

The fact that your insurance was billed that much does not mean it paid that much--not even close.

I'm well aware. My bills show what was submitted and what was actually paid out. The submitted number was well over $120k after all was said and done. What was paid out was maybe 30% less.

The whole thing cost me maybe $500 out of pocket in copays. Initially I was going to use my own blue cross insurance (as a self-employed person) but the Dr I wanted (Dr. Ebersole) was out of network. I paid out of pocket to see Dr Ebersole and get a diagnosis, but unfortunately even with my insurance I would have been paying at least $18k personally if I moved forward with closure. I ended up seeing another cardiologist in Gainesville who's done a few cave divers' pfo's. They required a transesophageal echo (Dr Ebersole did not). I was told in-office that my insurance was going to cover most of it and I just had a $250 copay. When the hospital called me the day before, they said they needed to collect $3500 in order to move forward. I declined the procedure at that point.
Luckily my wife was in the process of job hunting and got a job with the state of florida. The state insurance is still blue cross, just a different plan. With her plan the procedure and appointments basically cost me nothing.
Our insurance system is very, very broken.
I was very lucky that my wife got the job she did. In the 6 months between my official diagnosis and getting it closed, I continued to dive. I knew I had one for several years, but the local cardiologist couldn't diagnose it because he said a valsalva during the bubble study was unnecessary. That didn't seem right to me. I eventually heard Dr Ebersole's name more and more and that's why I decided to go to him. I won't lie though, once I had the known diagnosis I did dial back my dive profiles some.
Dr Ebersole and his staff went above and beyond to work with my schedule and get me treated. Even when I let them know I'd have to go to an in-network cardiologist. My understanding from someone who had closure without any insurance at all, is that the cost is dramatically less for the uninsured but still pricey