UNM Doctors Say They Wish They Could Do More to Help

After waiting nearly a year, Sam (not his real name) finally got the knee surgery his doctors at UNM Hospital had told him he needed if he wanted to walk again. His ordeal began in 2015 when he first sought relief from debilitating knee pain at UNM Hospital.  An MRI showed a torn ACL and torn MCL that could only be repaired with surgery. The price tag: $62,404. This man supports his family of five on his annual income of $30,000. He has no benefits and does not qualify for Medicaid or UNM Care.

He lived with the knee pain as long as he could before returning to his primary care doctor at First Choice. He tried steroid injections and self-care, but his knee was too damaged. His surgeon at UNMH Orthopedics said his knee would continue to deteriorate unless they operated.  Surgery was scheduled for the fall of 2016. The process of applying for the self-pay discount took longer than expected, and his surgery was rescheduled for February of this year. It was delayed again when he was asked for additional income documentation to prove that he was unable to pay. Finally, he was approved for self-pay discount program in May and he rescheduled his surgery for mid June, 2017. 

At the beginning of June, he received a call from UNMH giving him the estimate of the down payment that would be required in advance. The estimate was for $17,161, which is 50% of the discounted amount of $34,322 (or 55% of the “sticker price”).  He could not come up with $17,161, so UNMH cancelled his surgery.

He couldn’t bear the pain any longer, as it was impacting his ability to work to support his family and to participate in daily activities.  He reached out to a local non-profit organization, Centro Savila, for help.  A Pathways Navigator accompanied him to his next appointment with the surgeon and with the financial assistance counselor. His doctors were very apologetic, telling him that they wished they could do the surgery, and they wished him good luck with figuring out a financial solution. In the meantime, they prescribed him a brace.

The financial assistance person once again advised him that he needed to pay $17,161 upfront before the surgery could be scheduled. When asked what ever happened to the affordable down payment schedule that used to be in place, the financial assistance person told him that unfortunately, it had been changed recently.

It was only after his Pathways Navigator intervened on his behalf that the financial assistance counselor went to ask the doctors if they wished to file a new, special appeal to the Chief Medical Officer. Apparently the doctors didn't know such an appeal process existed. They agreed to file an appeal, and thankfully, the surgery was rescheduled and the 50% down payment as deferred in this case.


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