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Q: Thyroid Surgery Costs and Heatlh Care ( Answered 5 out of 5 stars,   1 Comment )
Subject: Thyroid Surgery Costs and Heatlh Care
Category: Health > Conditions and Diseases
Asked by: terukun01-ga
List Price: $100.00
Posted: 09 Nov 2005 14:21 PST
Expires: 09 Dec 2005 14:21 PST
Question ID: 591184
This is a two part question:

I realize laws and costs are different by state, so I would like to
state that I currently reside in the state of CA, in Orange County,

Part 1: 

My girlfriend was recently diagnosed with a multi colloid goiter, and
the doctors have recommended surgery (ThyroidectomyL removal of the
thyroid). I would like to know, how much this would cost an individual
without any insurance coverage for someone located in the Orange
County, California area ( This would include hospital stay, surgeon
fee's, anethesiologists, etc.). Also, with a thyroid removed,  a
person must take Thyroid medication for the rest of their life - So I
would like to know what it would cost someone on a regular basis to
take this medication. These costs that are specified should be recent
costs rather than costs from the late or early 1990's.

Part 2: 

My Girlfriend recently switched her job to something that has health
insurance benefits, but the insurance company (Guardian) refuses to
cover this surgery and medication stating it was a "pre-existing
condition". Since the main purpose of her switching jobs was to have
the insurance, is there something that she can do, or a law the states
that the "pre-existing condition" exclusion only lasts a certain
period of time? The question is: Is there a solution for her to be
covered by her insurance company and somehow get around this
situation? Is she going to have to foot the bill for all these
surgical costs?
Subject: Re: Thyroid Surgery Costs and Heatlh Care
Answered By: welte-ga on 09 Nov 2005 17:40 PST
Rated:5 out of 5 stars
Hi terukun01-ga, and thanks for your question.  I sympathize with you
and your girlfriend's plight, having gone through some rocky uninsured
times myself.

Probably the most reliable data on procedure costs comes from the
government H-CUPnet (Healthcare Cost and Utilization Project)

Data is aggregated at the state (not city) level, but can be broken
down by metropolitan vs. other regions.  The most recent data for the
state of California is from 2002.  Here are the results for partial or
complete thyroidectomies:

Uninsured, metropolitan: $18,246
Medicare, metropolitan: $16,885
Medicaid, metropolitan: $17,996
Commercial insurance, metro: $15,379

The overall average for all payer types for metropolitan patients was
$16,008.  There were a total of 6,192 procedures performed in
California in 2002.  There were only 62 thyroidectomies performed on
uninsured patients in 2002.


Much more information is available through the above database.  Here's
how to obtain this or similar information on your own:

Visit the H-CUPnet site:

Select "State Statistics"

Select "Medical Professional"

Select "Statistics on specific diagnoses or procedures"

Select the symbol for California, 2002 (or any other year)

Select " Procedures grouped by Clinical Classifications Software (CCS)?"

Select "Principal Procedure:

Type in "thyroidectomy"

Click "Search"

Select "Next"

On the next page, you can select the information you're interested in,
for example, hospital charges, mean, etc.

Select "Next"

Select "All patients in all hospitals," "Payer," and "Hospital
Location"  Feel free to select other options, such as "Hospital bed
size: small, medium, large."

Select "Next"

On this page, select how you'd like the data displayed.  The first
choice is simpler to understand, but the second gives more
information.  I chose the second to see a more detailed breakdown of
the data. (Two-way tables)

Select "Next" and you will be presented with multiple tables of data
broken down as specified.


As you state, once the thyroid is removed, a person must take thyroid
replacement medication.  Synthroid (levothyroxine) is one of the most
popular hormone replacements.  You can find information about it here

The typical dose is 1.6 mcg/kg/day.  For a typical woman, this works
out to about 125 micrograms once per day.  The dosage needs to be
adjusted for each individual based on their response.  Based on this
dose, you can compare prices at multiple pharmacies via

The best price in the US is $17.79 for 30 pills ($0.59 per pill) at
CVS.  The total cost over a lifetime would depend on many things, such
as how old your girlfriend is now, any other medical problems, family
history, life expectancy, any possible dose adjustments, and the
possibility that the price of Synthroid will go up or down over the
course of treatment.


The specifics of pre-existing conditions within the context of your
girlfriend's health insurance policy are difficult to comment on,
since each employer can negotiate individual contracts with health
insurance providers with their own terms and conditions.

If your girlfriend had had previous health insurance, then code AB
1672 may apply, which requires that individuals who switch insurance
coverage (excluding Medi-Cal) still be covered for this condition
under their new insurance.  You can read more about AB 1672 here:

More relevant to your girlfriend's plight is this California
Consumer's Guide for California Health Insurance:

This document describes the state and federal limitations on what
health insurance companies can exclude as pre-existing conditions. 
Section 2 of this document states the following:

"When you first enroll in a group health plan, the employer or
insurance company may ask if you have any pre-existing conditions. 
Or, if you make a claim during the first year of coverage, the plan
may look back to see whether it was for such a condition.  If so, it
may try to exclude coverage for services related to that condition for
a certain length of time.  However, federal and state laws protect you
by placing limits on these pre-existing condition exclusion periods
under group health plans.  In some cases your protections will vary,
depending on the type of group health plan you belong to.

 * Group health plans can count as pre-existing conditions only those
for which you actually received (or were recommended to receive) a
diagnosis, treatment or medical advice within the 6 months immediately
before you joined that plan.  This period is known as the look back
 * Group health plans cannot apply a pre-existing condition exclusion
period for genetic information.  Also, these plans cannot apply a
pre-existing exclusion period for pregnancy, newborns, newly adopted
children, children placed for adoption, provided they are enrolled
within 30 days.
 * Group health plans can exclude coverage for pre-existing conditions
for a limited time.  The maximum exclusion period depends on the type
of group health plan you are joining. If you are joining a fully
insured group health plan in California, the maximum exclusion period
is 6 months.  If you are joining a self insured group health plan, the
maximum exclusion period is 12 months. You will receive credit toward
your pre-existing condition exclusion period for any previous
continuous coverage.
 * If you enroll late in your group health plan (after you are hired
and not during a regular or special enrollment period), you may have a
longer pre-existing condition exclusion period.  If you are a late
enrollee, you may have a 12-month, pre-existing condition exclusion
 * Group health plans that impose pre-existing condition exclusion
periods must give you credit for any previous continuous creditable
coverage that you?ve had.  Most types of private and government
sponsored health coverage are considered creditable coverage."

Your specific situation may be somewhat more complicated because
certain entities in California have opted to exempt their covered
employees from some of the health insurance protections.  These are
listed in Section 2 above.  Employees of Orange County are on this
list, as are some school districts and other counties.


Section 5 of the above Consumer's Guide also details possible
financial assistance for health related expenditures:

Unfortunately, few of these options are viable unless she is pregnant
and making less than 200% of the poverty wage, which is $9,310 (so
total of $18,620).  In this case, she would qualify for Medi-Cal.

Here's a printable version of the Consumer's Guide referenced above:

I would recommend speaking with the Human Resources director at your
girlfriend's place of employment and explaining the situation.  They
may be able to help.   There are also multiple resources in the state
of California who deal with health insurance issues.  Here is a good
list of the main agencies:

The Cancer Center at UCSF has a very good page for their patients in
need of health insurance, with a section focussing on pre-existing

Some of the options they discuss may work for her as short-term solutions.

Also, if you're interested, you can read more about multi-nodular
goiter at these sites:


Endocrine Web:


I hope this information is helpful.  I wish you and your girlfriend
the best in getting through this stressful time.  Please feel free to
request any clarification prior to rating.

Clarification of Answer by welte-ga on 10 Nov 2005 05:16 PST
Another option your girlfriend should explore is applying for free
care through a hospital that performs this procedure.  She may also
qualify for a reduced rate, based on any financial hardship.

I agree to some extent with the commentor who stated that a second
opinion is wise, especially before surgery.  I do not agree that
surgeons are just out to recoup their malpractice premiums.  They
typically simply stop practicing medicine in areas where the premiums
are too high to recoup via ethical medical practice.  This is why, for
example, there are few if any private practice neurosurgeons in
Pennsylvania, and why so many neurosurgeons are no longer doing
intracranial procedures, limiting their practices to spine surgery.


Request for Answer Clarification by terukun01-ga on 10 Nov 2005 09:00 PST

Thank you for the wealth of information that you have provided. YOu
have answered part 1 to the fullest and I am completely satisfied with
that answer.

As far as part 2 is concerned, you have provided great information
here too, but I would like some clarification.

I read through the information regarding the look-back period, and
that was 6 months for people with group health insurance ( which is
what she has ). So in more simple terms, can I understand this to mean
that if she was currently employed at her job for 4 months, and she
received some procedures / recommendations for surgery  at the 2 month
mark of her employment, does this mean that if she waits another 6
months, the health insurance company cannot invoke the pre-existing
exclusion clause on her?

I ask this because earlier in your analysis, you stated that it would
be difficult to assess the situation as every employer can negotiate
different terms. Does the negotiation include terms regarding
look-back periods?  As in, can they extend these look back periods? or
is that something that as a citizen, we are protected under federal
law, and that the look back period is regulated to be 6 months, and is
a non-negotiable item?  Is this something you could tell me, or is
this something only the health insurance company in question can tell

Im hoping that the look-back period is mandataed by federal law, and
cannot be changed, as my girlfriends case of her goiter is relatively
minor, and she is willing to wait a few months if it means less cost
for her in the future.

I appreciate your suggestions about free health care, but she makes
much more than the poverty line, so free care would pretty much be out
of the question. HOwever, $20k out of ones pocket is quite a bit of

Clarification of Answer by welte-ga on 10 Nov 2005 10:31 PST
Hi again, I believe you are on the right track... To re-quote a
section from the site:

"Group health plans can exclude coverage for pre-existing conditions
for a limited time.  The maximum exclusion period depends on the type
of group health plan you are joining. If you are joining a fully
insured group health plan in California, the maximum exclusion period
is 6 months.  If you are joining a self insured group health plan, the
maximum exclusion period is 12 months. You will receive credit toward
your pre-existing condition exclusion period for any previous
continuous coverage."

This means that each group health plan can decide to exclude
pre-existing conditions for insured employees, but they can only
exclude the condition for 6-12 months, depending on the type of
insurance.  Since your girlfriend falls in the fully insured group
health category, the maximum exclusion period should be 6 months.  If
she were paying for the insurance herself, the maximum  exclusion
period would be 12 months.

So, this means that Guardian can exclude her condition for a total of
6 months from the time at which she became insured.  After that point,
they should cover it.  A good example may be someone with a chronic
disease, such as diabetes.  The insurance company could exclude this
condition and all of the subsequent complications forever if there
weren't some type of clause such as that above be useless (but very
profitable) for all but the most healthy.

As usual, this is not a substitute for medical or legal advice.  I
would recommend talking with the Human Resource office, since they
certainly deal with this type of situation frequently and may be able
to help with navigating the specifics of the policy that has been
established between your girlfriend's employer and Guardian.   There
may be some specific forms, etc., for notifying them of the date of
onset of a pre-existing condition, etc., and you would want to have
everything in order to minimize the chance that her claim will be
denied after the look-back period has expired.



Clarification of Answer by welte-ga on 10 Nov 2005 10:55 PST
Thanks for the kind words, high rating, and generous tip!

terukun01-ga rated this answer:5 out of 5 stars and gave an additional tip of: $15.00
Welte-ga. The response was exceptional, and I cannot begin to state
how pleased I am with your thorough and thoughtful answers. Everything
was  categorized in a professional, easy to understand manner that
saved me a tremendous amount of time.  One word: EXCELLENT!

Please accept the tip as my gratitude for the wonderful job you
performed. Have a cup of coffee or a drink on me. Thanks again!

Subject: Re: Thyroid Surgery Costs and Heatlh Care
From: scotttygett-ga on 09 Nov 2005 23:54 PST
A friend had this surgery. I looked it up, and the available
treatments seemed to provide next to no gains in exchange for a lot of
grief. So, with great respect for most doctors, living under the thumb
of malpractice insurance, I share a well-worn joke:

The doctor said, "Joe, the good news is I can cure your headache. The
bad news is that it will require castration. You have a very rare
condition, which causes your testicles to press on your spine and the
pressure creates one hell of a headache. The only way to relieve the
pressure is to remove the testicles."

Joe was shocked and depressed. He wondered if he had anything to live
for. He had no choice but to go under the knife. When he left the
hospital, he was without a headache for the first time in 20 years,
but he felt like he was missing an important part of himself. As he
walked down the street he realized that he felt like a different
person. He could make a new beginning and live a new life.

He saw a men's clothing store and thought, "That's what I need... a
new suit." He entered the shop and told the salesman, "I'd like a new
suit." The elderly tailor eyed him briefly and said, "Let's see...
size 44 long." Joe laughed, "That's right, how did you know?" "Been in
the business 60 years!" the tailor said. Joe tried on the suit; it fit
perfectly. As Joe admired himself in the mirror, the salesman asked,
"How about a new shirt?" Joe thought for a moment and then said,
"Sure." The salesman eyed Joe and said, "Let's see, 34 sleeves and
16-1/2 neck." Joe was surprised, "That's right, how did you know?"
"Been in the business 60 years!" Joe tried on the shirt and it fit
perfectly. Joe walked comfortably around the shop and the salesman
asked, "How about some new underwear?" Joe thought for a moment and
said, "Sure."

The salesman said, "Let's see... size 36." Joe laughed, "Ah ha! 
I got you, I've worn a size 34 since I was 18 years old." The salesman
shook his head, "You can't wear a size 34. A size 34 would press your
testicles up against the base of your spine and give you one hell of a

New suit - $400 
New shirt - $36 
New underwear - $6 
Second Opinion - PRICELESS 

Threaded Discussion: 
  Joel M. Fine Oct 23 2005 2:27PM

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