At the Breast Health Institute of Houston (BHIH), Dr. Miltenburg is able to provide high quality, affordable surgery for patients who pay for themselves. Even patients with health insurance find that it often costs less to pay cash, especially for minor procedures, than to use insurance and overpay with huge deductibles, co-pays, etc. In addition, Dr. Miltenburg works with facilities that provide affordable, related services such as mammograms, ultrasounds, pathology and surgical facilities.
Consultation – $185.00
This is the initial office visit. Dr. Miltenburg will interview the patient, perform a physical examination and review documents that the patient brings to the visit such as mammogram reports, pathology results, etc. It is critical for patients to be aware that it is their responsibility to ensure that all relevant medical reports have been received by Dr. Miltenburg’s office before the appointment or are brought to the office on the day of the appointment. Patients should not rely on anyone but themselves to email or fax their reports to Dr. Miltenburg. This one of the most important things a patient can do for herself. BHIH receives less than 10% of all necessary test results when a patient relies on the referring doctor’s office or breast imaging center to send them. Patients will have to schedule a follow up appointment to review reports that arrive after the consultation. This is costly and delays care.
Follow-up appointment – $75.00
After the initial consultation, each time the patient comes to the office it is considered a follow up visit. This usually takes place once or twice a year.
Post-op appointment (included)
Office visits are free for 90 days after surgery. The average patient needs to come to the office 1 or 2 times after surgery. In the case of minor surgery, post-op visits can sometimes be done via telemedicine or telephone.
Co-ordination of Care (included)
Some patients, such as those with breast cancer or other complicated conditions, need to see several different specialists and/or have additional tests. In these cases, Dr. Miltenburg will personally coordinate the referrals and tests. This service is included in the consultation and/or follow up visit.
Examples of minor surgery include removal of a breast mass, aspiration of a breast cyst and drainage of an abscess. Minor surgical procedures are usually done in the office. We use local anesthetic or local anesthetic with sedation so there is no pain or very little pain. If necessary, a nurse anesthetist is available for office procedures for an additional cost.
Examples of major breast surgery include mastectomy (complete removal of the breast) with or without reconstruction. Major surgical procedures are done in a hospital. The hospital fee is based on how long the surgery takes. All tissue that is removed is sent to the pathology lab for analysis (this is sometimes called “biopsy”).
Dr. Miltenburg’s office coordinates everything. The patient is given written instructions and prescriptions prior to surgery. The surgical fee must be paid in full with a cashier’s check prior to surgery. For 3 months after surgery the post-operative visits are free. Although rare, complications may occur and management of complications are not covered in the price of surgery.
If surgery is done at a hospital the patient will be billed separately by the hospital. If pathology is necessary, the patient will be billed separately by the pathology group. There is no balance billing and no surprise charges.
Example of a self-pay patient
Mrs. Welbeing was a 63-year-old school teacher in Africa. She had 3 sons who all immigrated to the United States. When Mrs. Beautiful developed a malignant mass in the breast, her sons flew her to Houston. I evaluated the patient and the medical records that she brought with her and together we determined that the breast would have to be removed. She did not want reconstruction. Her mastectomy surgery was successful and two weeks later she got on a plane and returned home, cancer free. Mrs. Welbeing also took with her a one-year supply of the cancer pill Arimidex, to prevent the cancer from coming back.
Total cost of surgical care: $9,885.00 (approximate U.S. dollars)
Another fee-for-service scenario
Ms. Angelo lived in south Texas. She had a large cancer in her breast and came to Houston where she received chemotherapy that shrunk the tumor to the point where it could not be felt anymore. However, unless the “root” of the cancer was removed, it would come back. So, I performed a lumpectomy (partial mastectomy) and removed some of the lymph nodes in her arm pit because they had also been malignant. Ms. Angelo had a successful operation, stayed in the hospital overnight and the following day her daughter-in-law drove her back home to the Mexican border.