Thursday, August 6, 2009


Well, Folks, I just got back from having surgery. It was nothing serious (provided you catch it early like I did) and was completed in the doctor's office. I developed a Basal Cell Carcinoma right in the middle of my forehead and it was removed by Moh's procedure. It should have lasted all day as they cut, analyze and cut again until all cancer has been removed. Only two cycles were necessary to get it all. So, I was out early.

That's one part of my story. The other part is the conversation I had with the doctor when he was done. "You want me to close up the hole or let it heal by itself?" he asked.

"You decide," I responded.

"No, it's your choice. Here are the ups and downs. If you let it heal by itself, it could take several weeks to heal completely and it could leave a scar, smaller than the size of the hole but larger than if we should close it up. Closing it up could take about 10 days to heal with a very small line-scar. You pick."

"How much is it going to cost me to have you close it up?" I asked, because, as you know, I pay cash. (The doctor also knew and we pretty much fixed the price before I showed up.)

"Oh, I see there's more work on your face later, so I'll close it up for you at no cost. And, I'll cut you a break on the price because we caught all of it pretty quickly."

"OK," I said in the face of such a good offer. "Close the sucker up, Doc."

He spent about 35 minutes doing some fancy suturing and I was out to pay the girl up front. She showed me the cost-worksheet and this is how it went down:

Closing of the wound:$750.00 (No Charge)
Discount on surgery:$250.00-
Total due:$1,000.00

So, a $2,250 bill became $1,000. She said I am good to go; they will send me a bill. My first thought was, that's unfair because I have nothing that the doctor can repossess should I not pay. Is he going to put my carcinoma back? Then, she added, unless you want to make a partial payment today...

She made me proud. Good girl. That's how capitalism is supposed to work. It's not cold-hearted and one-sided. It's compassionate and honest. Ask for money if you are owed any. Don't offer to send a bill if you are not prepared to wait for your money.

For the cash-for-medical-service to work it is crucial that the doctor take cash in that day, otherwise it becomes nothing but a pay-later medical scheme. (I almost wrote 'scam'). So, I offered to partial-pay $500 on the spot.

Since the money is in the bank, I'll pay the bill as soon as it arrives. I want the doctor to be happy to see me again and in-profit to continue providing his best service to me.

We are both happy: provider and consumer. Life is good.


  1. I'm glad that the surgery went well, Nico. But, good golly, possibly having to pay $750.00 for some stitches. I see why you jumped at a zero cost to close up the cut.


  2. Hi Moe.
    The Moh's procedure leaves such a big hole, it's not merely putting in 'some stitches.' It requires cosmetic surgery (some say plastic surgery but there's only real flesh involved, I assure you) to make the scar almost invisible, which is the expensive part. So, I got a very good deal.

  3. On the other hand, Moe, if this had been an insurance case, there would have been no mention of costs. The doctor would have sewn up the hole without asking a question. The patient would been none the wiser as to the cost added to the entire health care bill.

  4. Hi Nico,
    Glad it all went well, but I cant help but think how this would work if applied to more and more procedures. Image being woken up after a by-pass surgery and asked if you want the wound closed, or let it heal by itself :)

    Or when you go in for surgery they ask you if you want the full monty on anesthesia or the budget version. On the full service you wake up the next day a little drowsy, on the budget version you can follow the surgeon discussions in the back ground :)

    Also just wondering.


  5. Good question, Theuns.

    Reflecting on it, I guess if it was more than mere aesthetic value, the Dr. wouldn't have offered that as a choice. That he did pleased me, because, after all, it's my choice and a choice that I have to live with that has nothing to do with the outcome of the surgery, per se.

    If it was more than aesthetic value, I cannot imagine that he would have given me a choice. Just as the level to which he removed the cancerous skin wasn't an option. It was a matter of cutting until all the cancer was out.

    Good to hear from you.


Comments are moderated. Comment to your heart's content. I will not publish all comments but only the best of those that are pithy, relevant, smart and in good taste.

About Me

Seeking the truth until I find it.