My Spinal Surgery Experience in the DR
Last activity 10 April 2024 by RockyM
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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.
You mentioned approximately $2,300 for out of pocket but may go lower. Any idea how much it would have cost you if you did not have insurance?
How long have you been on the Humano plan for?
Also, any major surgery you need to do in Santo Domingo?
How do you feel post surgery any other effects? The infection gone?
Many countries like DR get bad a bad stigma for the health system but did not seem bad overall.
Thank You for sharing your experience Will be living in LT full time soon and this helps a lot.
So glad to hear everything went well for you! I have the same exact issue with my back exactly as you described and same L4 L5 S1. I need a fusion per surgeon but I am afraid to do that so I live with the pain for now. Please keep us inform how you are healing and if the pain went away! I have years of damage as I ran marathons for many years and the impact finally caught up to me! So there is hope for me lol!
Glad you are ok Rocky. Now the recovery period. I have the same issue you have coupled with 2 herniated discs in my neck and 2 pinched nerves in my neck but I am managing the pain although its not easy. The neuro surgeon told me surgery 2 years ago and right now I am just holding my own. I hope your recovery period is a speedy one and thank-you for sharing your experience in such great detail. I sure it will be beneficial to many.
First off, I am so happy for both you and Denise that this went as well as it has.
I can only imagine the worry and stress all of this was on the two of you. Your continued sharing with us all here is amazingly wonderful. Thank you so very much for sharing in such detail all that you have in regards to everything related to your back surgery with us all. It was very enlightening.
After I first read your posting, I read it again to my wife. I seem to be the one between my wife Fran and I that is doing the extensive research in all things retiring to the DR. Your posting that I shared with my wife was a positive reenforcement of the many positive things that the DR has to offer us as ex-pats retiring to a new country.
Dave and Denise, I must sincerely thank you both for all of your contributions you make here on this board. I have learned much about the DR and Las Terrenas though your posts and direct messaging you with specific questions I have had.
I look forward to the day my wife and I have the pleasure of thanking you in person 
Dave, I wish for you a speedy and continued successful recovery
PS. Some how I am not surprised that Planner was able to be helpful in some capacity, as from all that I have read here on this board, Planner is a very caring compassionate helpful lady. Way to go Planner
What a great, detailed report. Thank you so much for sharing, and I'm happy for you and Denise that you are on the road to recovery! :-)
Hello RockyM,
Thank you for this detailed post and for sharing your experience with us.
We hope that you are feeling better now.
All the best for the future,
Yoginee
Expat.com
@RockyM
thank you so much for this extremely well detail of your experience.
You mentioned approximately $2,300 for out of pocket but may go lower. Any idea how much it would have cost you if you did not have insurance?
Insurance paid $1850 US for the hospital, $1900 for materials, $4400 for the surgeon, So in all that is $10,450 US. This does not include prescription costs paid by insurance. We don't have that information.
How long have you been on the Humano plan for?
2 1/2 years
Also, any major surgery you need to do in Santo Domingo?
My surgery had to be done in SD. The only other place I would consider surgery is Santiago. I think it would depend on the type of surgery as to where it is performed.
How do you feel post surgery any other effects? The infection gone?
The incision site has been sore, with some swelling. The surgeon indicated the nerves are affected by the surgery - unavoidable for this type of surgery, so it will take perhaps months before I am totally healed.
Many countries like DR get bad a bad stigma for the health system but did not seem bad overall.
I can't say there was no concern on my part, but many people fly into the DR for surgeries every year with successful results. My surgeon was trained here in the DR. Our home town doctors were as well. They indicate their school medical program followed the Harvard Medical curriculum and a fraction of the students graduated due to the challenge of the program. So, I gather my doctor is no slouch ;0)
For those commenting with current back issues I tried living with the discomfort for some time but it got so bad I couldn't take it anymore. I think spine surgery like this really is a last resort. I can take pain pretty well so I would have just lived with it, but if you have experienced sciatic pain it can be debilitating. Denise got tired of my loud screaching whenever I moved in a certain way.
Insurance paid $1850 US for the hospital, $1900 for materials, $4400 for the surgeon, So in all that is $10,450 US. This does not include prescription costs paid by insurance. We don't have that information.
-@RockyM
I'm not sure if it's true, but I have been told that the hospitals have one rate for people with insurance, and another much higher rate for people without insurance.
Insurance paid $1850 US for the hospital, $1900 for materials, $4400 for the surgeon, So in all that is $10,450 US. This does not include prescription costs paid by insurance. We don't have that information.
-@RockyM
I'm not sure if it's true, but I have been told that the hospitals have one rate for people with insurance, and another much higher rate for people without insurance.
-@rellosk
That could be. I know in the US they play those games with the insurance companies. It is probably pretty common in markets everywhere.
@RockyM
Thanks for providing and hope all works out.
On the out of the pocket in which you feel won't be reimbursed is mainly the larger room in which if you took where the regular room they would have covered?
There was no "regular" room in that clinic. One size fits all!
@planner
I guess that is why I am confused why insurance would not cover or is not yet?
It is and was covered up to the coverage limit. Go back to the original post and see what "was" covered. He lists the room tv air etc etc. As I read it that was covered.
Rocky can you confirm a bit better what was NOT covered?
Yes Planner the room was covered in full. The only things hospital related not covered was Dermabond (sort of a SuperGlue for surgery), and a few minor items.
DRVisitor, I see where the confusion may be. The items bulleted in my original post (i.e. room, neurosurgeon,...) were covered by insurance. I was trying to emphasize what was included in the medical treatment I received.
We have a very detailed statement from the hospital with every IV bag, pill, and bandage itemized! I wouldn't say I've studied it in detail, but I can confirm that items were either covered completely or not at all - there was nothing that was only partially covered in the hospital bill. Every single thing we had to pay for (maybe 10 items on a 4-page list?) was something that wasn't covered. The Dermabond was the largest single item at about 4000 DOP. I also recall there being something for about 500 DOP related to the sterilization of instruments (happy to pay for that!). Everything else was fairly small amounts since the total that we paid was right around 8000 DOP.
Mrs. RockyM (aka Denise)
@RockyM interesting and well written sir. A friend recently went through the same symptoms and surgery. She is relatively young and bounced back with no issues. Weird thing is same surgery, same insurance, same doctors. And yes, that same procedure in the USA would easily have passed six figures.
Thanks
@RockyM interesting and well written sir. A friend recently went through the same symptoms and surgery. She is relatively young and bounced back with no issues. Weird thing is same surgery, same insurance, same doctors. And yes, that same procedure in the USA would easily have passed six figures.
Thanks
-@edseitz
All about reputation and always good to hear first hand though every surgery will be different and complications associated with it
@RockyM interesting and well written sir. A friend recently went through the same symptoms and surgery. She is relatively young and bounced back with no issues. Weird thing is same surgery, same insurance, same doctors. And yes, that same procedure in the USA would easily have passed six figures.
Thanks
-@edseitz
Thanks! Good to know of another success story. The surgeon seemed very confident in the procedure and himself. :0)
Good to hear your recovering well , I too have a horrible back problem that I deal with
that i won’t go into details about , but your post of the surgery was inspiring and greatly appreciated by me knowing that maybe I won’t have to settle for two Titanium rods fused into my spine……I hope your recovery will continue on a positive path forward and remember baby steps before leaps……good luck
Good to hear your recovering well , I too have a horrible back problem that I deal with
that i won’t go into details about , but your post of the surgery was inspiring and greatly appreciated by me knowing that maybe I won’t have to settle for two Titanium rods fused into my spine……I hope your recovery will continue on a positive path forward and remember baby steps before leaps……good luck
-@Tippj
Thanks! Spinal surgery is advancing every year. It never hurts to get some different opinions....
@Ian1272 he's doing great! It will be a while before he's at 100% (still some swelling), but every day is better than the one before!
Denise (aka Mrs. Rocky)
Slow and steady , Remember patience is a virtue….. the rewards will be plentiful amego
On the topic of surgery, but off on spinal.
I found the information on insurance interesting and thought I’d like to quickly review our experience. While we now have Humano Max, at that time we only had our US insurance.
Two years ago my esposa took a fall down some steps at a local restaurant here in Cabarete. No surprise that there was one uneven step in the flight, this is the DR.
As a result, she managed to break the ball of her left shoulder, leaving it looking more like a sliced pizza than a bone.
We took her to the Cabarete Médico Centro (CMC), a private hospital in Sosúa . Since we did not have DR insurance then, they required a 2,000 usd down payment before proceeding. We had to make a decision to return to the USA or have the surgery here. Fortunately, we had friends here familiar with the facility and the doctors. They (and some of their medical contacts) persuaded us to remain here.
All went well, and she now has a titanium plate in her arm with a bunch of screws, but the results were excellent and our follow up doctor visits back home confirmed this. The hospital experience was similar to Rocky’s, but the customer service levels there were a bit higher, probably due to the large number of expats here, and the administrator being fro the US.
The total bill, for the surgery, hospital stay, doctors etc. was 22K usd. In the USA we have been told it would be well over 100K.
Our US insurance paid 40% and delayed payment for months and months to CMC. To CMC’s credit, they worked with us patiently as I didn’t want to pay them the balance out of pocket for fear that my insurance company would scoot on us or tie us up endlessly.
Had we had DR insurance then we would have had a much less expensive experience!
Interesting,
My wife is just now cancelling her NoAmerican policy and getting DR insurance... hopefully international coverage
Rocky, glad to hear your recovery is going well.
You should consider becoming a writer! You have a great ability to convey an experience in an informative but still enjoyable style.
Hey Rocky
Hows your healing and recovery coming along ?
-@Ian1272
Great. I am busy installing a lightning rod system on our house, including some digging in the yard. So, it has not slowed me down. No nerve pain. My back still gets sore but that has nothing to do with the surgery. Just muscle pain.
Thanks :0)
Rocky, glad to hear your recovery is going well.
You should consider becoming a writer! You have a great ability to convey an experience in an informative but still enjoyable style.
-@Mark and Al
Thank you! I did a LOT of business writing in my career. It comes to me naturally now. I would love to write creatively but I don't have enough imagination or patience. LOL.
The reputation of the hospital system is greatly overrated and with costs now as well in the USA.
@RockyM Tell me more about this insurance plan. I'm trying to find one that is worth it but won't break the bank
@RockyM Tell me more about this insurance plan. I'm trying to find one that is worth it but won't break the bank
-@Julia Palumbo
I would advise you reach out to our very own "Planner" here on expat.com. She adminsters the plans we have and could answer your questions I am sure.
David
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