# Surgery as Self-pay



## Jvicks (Aug 1, 2013)

I have a multi-nodular goiter on the right side of my thyroid. I got the FNA and the results were inconclusive. The ENT said some of the cells did look suspicious and that he recommended a partial removal. He did not think it would be unreasonable to wait 6 months and repeat the ultrasound and FNA, if I desired.

Not having insurance is clouding my decision. Most of the surgery needs to be paid in full, and as a college student, I cannot afford it. Overall, I'm not sure what is the best option. Finances aside, I want the nodule removed. I do not what to worry about it progressing to cancer, but also do not want a useless surgery.


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## joplin1975 (Jul 21, 2011)

Well...that's a predicament!

Most thyroid cancers grow very, very slowly. My surgeon estimated mine had been growing for 10 or so years. I certainly think you should be monitored closely, but I also don't think waiting will significantly increase your risk (assuming we are not talking about long term schooling, like 5-8 years?). Do you have a sense of when you will finish? Are there any school based insurance programs for students?


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## Velcro (Jul 26, 2013)

Also, if you don't want to wait, is there any way of speaking with the ENT, Hospital, etc., explain the situation and set up some type of payment plan?

P.S. Due to my research and the great information here, I did opt to wait 4 months to redo the FNA after mine came back inconclusive.


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## Andros (Aug 26, 2009)

Jvicks said:


> I have a multi-nodular goiter on the right side of my thyroid. I got the FNA and the results were inconclusive. The ENT said some of the cells did look suspicious and that he recommended a partial removal. He did not think it would be unreasonable to wait 6 months and repeat the ultrasound and FNA, if I desired.
> 
> Not having insurance is clouding my decision. Most of the surgery needs to be paid in full, and as a college student, I cannot afford it. Overall, I'm not sure what is the best option. Finances aside, I want the nodule removed. I do not what to worry about it progressing to cancer, but also do not want a useless surgery.


I agree; it sounds like it would be best to have the surgery. Well, you might have to work our some deals w/ the surgeon and the hospital and do you have access to financial assistance through your university?

This sure is a mess. Many folks simply cannot afford insurance premiums any more. You are not alone.


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## Jvicks (Aug 1, 2013)

Thank you for the replies, as I am new to this situation. I appreciate hearing opinions.

They are giving me a large discount on the surgery, which would be done as outpatient. I am not aware of any programs through my university. I will be graduating May 2014, so I could wait for a job (not promising), or the government health plan that begins in Jan. Oh, decisions...


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## Andros (Aug 26, 2009)

Jvicks said:


> Thank you for the replies, as I am new to this situation. I appreciate hearing opinions.
> 
> They are giving me a large discount on the surgery, which would be done as outpatient. I am not aware of any programs through my university. I will be graduating May 2014, so I could wait for a job (not promising), or the government health plan that begins in Jan. Oh, decisions...


The important thing here is what brought you to the doc in the first place and how are you feeling?

This is a really tough decision and it's one you personally have to feel comfortable with.

None of us can in good conscience tell you to wait; that I know for sure.


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## Jvicks (Aug 1, 2013)

Andros said:


> The important thing here is what brought you to the doc in the first place and how are you feeling?
> 
> This is a really tough decision and it's one you personally have to feel comfortable with.
> 
> None of us can in good conscience tell you to wait; that I know for sure.


My nurse practitioner discovered the nodule during a routine exam a few months ago. I have no other symptoms and my thyroid function is normal.


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## jenny v (May 6, 2012)

How big are the nodules? Are they causing you any discomfort in your neck/throat?

If not, I would agree with your ENT that it's not unreasonable to wait 6 months and see where you are then. If he's comfortable with it, you're comfortable with it, and you're monitoring the situation with him, it seems like it would be okay. Thyroid cancer is typically very, very slow growing. Maybe if you decide to wait you could start putting aside money for the surgery, if you decide to have it.


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## Octavia (Aug 1, 2011)

I agree with jenny's thoughts above. My FNA was inconclusive, and my ENT suggested a partial, but said there was no rush. She said not to wait years or anything like that, but waiting a few months would be okay.


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## Jvicks (Aug 1, 2013)

Up until today I was comfortable with the partial thyroid removal. I met with my surgeon this morning, and now I am undecided. First, I do not want to get a surgery that is not needed. Since the FNA came back "atypia of undetermined significance", I have been struggling with the decision. The results also stated that cells were mildly atypical and may represent discohesive Hurthle cells. Nothing is certain...

Ultrasound showed multiple hypoechoic nodules on the right measuring, 16x12 mm, 18x15 mm, 9x8 mm, 5x3 mm, and 6x4 mm.. Small mostly cystic nodule on left measuring 5x2 mm.

I am in a complete state of confusion. I know I can wait 6 months and repeat the FNA. I just wish there was more conclusive information to go off.

Thank you for reading my post!


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## Andros (Aug 26, 2009)

Jvicks said:


> Up until today I was comfortable with the partial thyroid removal. I met with my surgeon this morning, and now I am undecided. First, I do not want to get a surgery that is not needed. Since the FNA came back "atypia of undetermined significance", I have been struggling with the decision. The results also stated that cells were mildly atypical and may represent discohesive Hurthle cells. Nothing is certain...
> 
> Ultrasound showed multiple hypoechoic nodules on the right measuring, 16x12 mm, 18x15 mm, 9x8 mm, 5x3 mm, and 6x4 mm.. Small mostly cystic nodule on left measuring 5x2 mm.
> 
> ...


When undecided, don't make a decision to do something you might later regret. You can most likely safely wait 6 months and do a re-evaluation. I think your doctor agrees?

And in the meantime, if anything appears out of kilter, you know you are on board w/medical care.


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## Jvicks (Aug 1, 2013)

Thanks Andros! You are right, I do not want to regret this important decision.

This board has been a very helpful educational tool. 
Have a beautiful afternoon!


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## Andros (Aug 26, 2009)

Jvicks said:


> Thanks Andros! You are right, I do not want to regret this important decision.
> 
> This board has been a very helpful educational tool.
> Have a beautiful afternoon!


You have a wonderful afternoon as well and stick around so you can learn as much as you can so that "when" you have to reassess, you will very well informed.


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## Eliza79 (Jul 23, 2013)

I agree, I would continue to closely monitor and reasses in a few months, especially due to the high cost of paying out of pocket. I just had a partial due to a suspicious nodule, which turned out to be benign, and easily could have waited another year to deal with it. But, I have health insurance and so went ahead with the surgery. Atypia's of undetermined significance are usually benign, not always, but usually. Just make sure you keep an eye on it because it sounds like it will probably need to come out at some point and you don't want any of the nodules getting much bigger or developing malignant characteristics.


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## partyofsix (Jun 19, 2013)

I just wanted to chime in on the insurance. As someone that works for one of the largest health insurance companies and working hard to assist with implementing the Patient Protection and Affordable Care Act (national health reform), don't wait only because you think the surgery will be covered in full in 2014. I have not heard anything about that at all.

Come October, the Health Insurance Marketplace opens which will provide Americans another avenue in which to purchase health insurance. All insurance companies that are participating will be required to offer very similar, if not the same, insurance plans. There will also be tax credits available to assist with paying for the insurance in addition to some payment scales based upon income. This may help you being a student.

Do you have a parent I. Which you can go onto their health plan? As of 2012, insurers are equipped to allow parents to keep their adult children on the plans until they turn 26 (not sure of your age). That may be another option. Know though that there are some self funded insurance plans that were able to grandfather themselves in and not have to offer this though.

I hope this little bit of information helps!


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