As indicated in another thread I had spinal surgery on January 5, 2023, in Santo Domingo. I promised to write up my experience so hopefully others may benefit, if considering a major surgery here in the DR. The following is a brief recounting of my experience. I will try to be brief.
The Problem:
In November of 2022, I started having bad sciatic pain down my legs, with numbness down to my feet. I visited our local doctor here in Las Terrenas – United Doctors. They recommended seeing a spinal specialist in Santo Domingo – The Spine Center. They further suggested I have an MRI and x-rays completed prior to my appointment with The Spine Center. I had my consultation with Dr. Perrone with The Spine Center in early-December. I went to Hospiten in SD for the MRI the day before. We reviewed my MRI, and it was obvious there were some issues with two of my vertebrae. At the lumbar L5/sacral S1 joint, the disk had severely deteriorated. At the L4/L5 the disk had herniated and breached the spinal tunnel, which was causing my sciatic pain.
Proposed Solution:
The surgery recommended, and performed, included a diskectomy and a laminectomy. Without getting into too much detail the lamina is the boney protrusion you may see or feel down the middle of a person's back. It wraps around and provides protection for the spinal column. A laminectomy is the removal of one or more of these bone joints. A diskectomy is the removal of one or more of the spinal disks. I had these procedures done for my two problematic disks. The two disks removed were replaced by artificial disks made from a polyester material called PEEK (polyether-ether-ketone). Titanium screws and pins were then implanted to function as the lamina. And any boney growth was removed that may irritate the spinal cord. As messy as this all sounds the surgeon assured me this is a somewhat common procedure for my situation. These procedures are essentially a modern alternative to a “spinal fusion”, which has been done for years with mixed results. Artificial disks have been around for the last 20 years or so.
Risks/What Do I Do:
There are certainly risks for any type of operative procedure, especially involving the spinal column. Will it work? Will I have nerve damage? Infection? How much will this cost us? These and other concerns had to be weighed. In my case I had little choice. Surgery was necessary or I would experience considerable back and leg pain the rest of my life.
Choices:
So, as a resident ex-pat here in the DR what were our choices? The obvious choice was to have surgery here in the DR by Dr. Perrone with the Spine Center. We have good health insurance with Humano Max, and I was pretty sure they would cover the majority of the cost.
We could also go to another country and pay out of pocket, if we felt more comfortable having surgery performed in another country. How about going back to the USA for surgery? If you are not from the US you may not understand how ludicrously expensive health care is in the US. Surgery would be more costly there than anywhere in the world I suspect. I will resist getting on my soap box and railing about the US health care system. It is one of the reasons many, including Denise and I, choose not to retire in the US. And no, we are not old enough for Medicare or any type of US government-based benefit.
So, our choice was to have surgery here in the DR. We did our due diligence and were confident in Dr. Perrone and Clinica Abreu where the surgery would be done.
Insurance:
Prior to going any further with surgery preparation, we wanted to get pre-authorization from Humano and determine how much this was all going to cost us. Dr. Perrone had us submit paperwork to Humano indicating what the problem was and how it was going to be corrected. Our own Planner here on Expat.com provided some guidance for us as well. Thank you, Planner! The response from Humano indicated they would cover the surgery itself 100%. This included the surgeon's fees and the hospital fees. Part of the cost of the hardware – PEEK disks, titanium screws and pins – was covered by Humano, and we paid a portion out of pocket.
So, we were comfortable with the coverage and decided to proceed.
Pre-surgery:
I was required to obtain the following test results prior to surgery: 1) blood test, 2) chest x-ray 3) spinal x-ray, 4) bone density test, 5) cardiologist exam, and 6) consultation with the anesthesiologist. I feared getting these procedures and the logistics of this whole process more than the surgery itself. Seriously. Those living here for any length of time may understand this. I did not look forward to running around trying to get all these tests done in a culture that does not recognize the value of time, accuracy, and in some cases professionalism. My fears were partly well founded. I had a great experience at CentriMed in Santo Domingo, which provided my bone density scan and spinal x-ray. They were efficient, professional and treated me very well. The cardiologist in Las Terrenas was a different matter. She wanted my exam scheduled as close to the surgery as possible. Surgery was on a Wednesday. They scheduled the cardio exam for Monday. The President of the DR just happened to call for an impromptu holiday for that day! So, the office closed. I showed up on Tuesday morning, as instructed, and the cardiologist had decided to take another day off, just because, and didn't bother to tell me. So, we had no cardiologist, and the surgery was the next day. Denise obtained a referral for a cardiologist in Santo Domingo (through a friend) who was able to see us that afternoon. We made an appointment with the anesthesiologist for early morning on the day of surgery. So, not surprisingly, everything was down to the wire.
Surgery:
Check in at the hospital was a bit frustrating. We were advised it was necessary to have a COVID test result prior to admittance, which no one told us about. Luckily, they could do the test right there, then we would wait two hours for the results. This made me late for my own surgery. This didn't surprise me either.
I was then escorted up to my room, where I met the on-call doctor and my nurse. They promptly left without explaining anything or when they would be back. About 20 minutes later the nurse popped in with the paper surgical gown I was to put on. I was then pushed down to the operating room. The surgeon was there with the anesthesiologist. And someone I didn't recognize. This later proved to be the neurosurgeon partner from The Spine Center. I got fitted with an IV and it was lights out. Denise was left in our hospital room for the 4 hours of the surgery, in which time no one visited Denise to tell her the status of the surgery. After 3 ½ hours she started inquiring. At the 4 hour mark the surgeon came in to tell her the surgery went fine.
Post-Surgical Care:
The post-surgical care was good. I had my large private room, an on-call physician and my call button to summon the nursing staff when needed. The pain meds and other IV drips were reloaded promptly. The only issue I had was nausea, which was treated with an IV med. The food served for breakfast and lunch was horrible, as in prison quality. Breakfast was followed by a coffee service, consisting of a girl with a coffee carafe dropping in to provide a Dominican coffee. Not expected but appreciated.
The surgeon and anesthesiologist visited me the day after surgery to see how I was doing. I was released within 48 hours of surgery to head back to our hotel and remain in Santo Domingo for another day, as the surgeon recommended.
Once I got back to Las Terrenas the only post-surgery issue I experienced was an infection at the incision site. Based on the culture I obtained in LT, I had a common infection that is often picked up in hospitals. It is somewhat resistant to antibiotics, so it was a bit of a concern.
Cost:
As a reminder Denise and I are from the US, home of the free-market health care system, with their ten-dollar paper cups and toilet paper priced by the square (I am not really kidding here). So, the cost of my surgery here was simply a pleasant shock when we added everything up. I am convinced surgery in the US would exceed six figures and require legal representation.
Denise uses Quicken to track all our household expenses by category, so all our expenses pertaining to this surgery were accounted for. Costs were captured from the time of the initial doctor visit here in LT to the post-surgery care at home. Costs include everything related to the surgery no matter how minor, including things like Uber rides to the various clinics, prescriptions, gas and toll costs to Santo Domingo, etc. We used Marriott points for the hotel, so there was no expense there.
Our total out of pocket cost was $2,300 US. This does not include some of the outstanding insurance reimbursements from Humano, so that number should go down. I will point out this cost includes the following:
- A private hospital room, with bathroom, tv, desk, couch (which could be made into a bed), comfy chair, and air conditioner with remote (which I really appreciated since I felt cold one minute and hot the next). The room was big, with more space than we knew what to do with.
- An English-speaking on-call physician at the hospital at all times.
- The neurosurgeon to assist with the surgery (about $700 – one of the outstanding claims with Humano, we have no idea why this was not submitted to insurance and we had to submit the claim).
Conclusion:
Would we do it again? Like many things we've been through the last three years I wouldn't want to do it again, but yes, we would make the same decision. The experience was pretty much what we expected. Dominican culture is not consumer based, as it is in the US, so our consumer experience was lacking in some regards – we were not always kept informed or provided the information we needed, we had appointments cancelled, changed, or overlooked without our knowledge, being treated as a walking dollar sign, etc. Again, we expected this, and weighing the experience against the dollar value provided we would do it again. I hope sharing our experience will help some of you faced with a similar situation. If you have any questions I will try to answer them.
