Blog — Notes of a Plastic Surgeon

Welcome to my blog. I am a plastic surgeon in Seattle and have been in private practice since 1991. I've seen more than a few interesting faces and cases through my years spent in the exam room, the operating room and the emergency room. And I have an opinion on just about everything relating to plastic surgery (and a lot of unrelated stuff). If you like my blog, let me know. Thanks for reading! Lisa

Category: Health Care Costs

Obamacare – how it will affect my practice

December 3rd, 2013 — 2:48pm

Seattle Plastic Surgeon discusses how Obamacare will affect (or not) her practice.

blog obama careThere was a time about 10 years ago when I would have been totally stressing out over the changes coming with the Affordable Care Act a.k.a. Obamacare.  But that was then and this is now and I’m not stressing out because I don’t think Obamacare is going to affect the way I treat patients.  You see, I have not contracted with any third part payers – insurance, HMO’s, PPO’s, Medicare, Medicaid, etc. – for almost 10 years.  The only financial agreements I have for providing patient care is with my patients.

Years ago, I withdrew my contracts with all the third party payers because of lousy reimbursements and even lousier service and most of all, their interference with patient care.   Believe me, I tried to make nice with the insurance industry suits but after tearing my hair out for a couple of years, I just decided not to play any more and took my ball and went home.  And now I am so glad I did.

My patients don’t have to worry if I am “on their plan” because I am not on any plans.  And I don’t have to worry about signing lousy contracts that will put me back into the third party payer circle of hell I was in ten years ago.

I like to keep it clean, direct and transparent.  You come in with a problem.  If I think I can help, I let you know what it will cost.  (Actually most of my prices are posted on my web site.  Imagine that!)  You pay me to operate on you.  If your health plan may cover the procedure I am performing, we provide you with the information and documentation you need to take to your health plan for reimbursement.

This has worked so well for me for almost a decade and I cannot imagine going back.  I acknowledge that my situation is very different that that of a heart surgeon or a family practice doc.   But my guess is that in the next few years, more physicians will push away from their marsupial relationships with Big Insurance and Big Government and embrace a practice that allows for individualized patient care, high quality, transparent financial interactions and doctor happiness.

Thanks for reading!  Dr. Lisa Lynn Sowder

Financial Issues, Government and Politics, Health Care Costs

“Will my health insurance pay for this?”

October 15th, 2013 — 2:32pm

Seattle Plastic Surgeon offers unsolicited advice on determining if your health insurance will cover a procedure.

The first step is to read you health insurance policy.

The first step is to read you health insurance policy.

“Will my insurance cover this?”  I hear that question a lot, especially with the Affordable Care Act becoming law.  I even had a patient ask if Obama Care would pay for her breast lift!  Wouldn’t that be sweet?

Here are some tips on determining if your health insurance will cover a certain procedure or treatment:

1.  Read your health care manual.  Often the answer will be there.  If you don’t have a manual, obtain one from your employer or the insurance company.   If the manual says something like “no breast surgery is covered unless it is related to breast cancer”, insurance will not cover procedures like breast reduction or breast implant removal.  It’s right there in black and white.

2.  Call your insurance company and talk to someone in customer (that would be you) service.  You may get the run around or a phone tree from hell, but you should eventually be able to reach someone who can give you some answers.  Remember that you are their customer and you should expect good service.

3.  If you are getting what you feel is an unfair answer, talk with your benefits manager or even your state insurance commissioner.   Insurance companies are happy to collect their premiums but can be downright prickly about money going the other way.  Sometimes they need a little prodding.

4.  Have your doctor’s office call.  Sometimes the insurance companies have a problem with plain English and do not understand a questions such as, “My breasts are ginormous and are killing my back and I’ve maxxed out my physical therapy budget and industrial strength bras don’t help.   Is breast reduction a covered procedure?”   The person in preauthorization may only understand “611.1, 724.5, 781.9 and 19318-50”.  Your doctor’s office can provide those numbers.

And remember – just because insurance does not cover a procedure or treatment, that does not mean you cannot have said procedure or treatment done.  It’s just that you will have to pay for it.

Thanks for reading and let’s hope this Obama Care thing works out!  Dr. Lisa Lynn Sowder

General Health, Health Care Costs

David Sedaris explains why America spends so much on heath care.

March 30th, 2012 — 6:24pm

Seattle Plastic Surgeon loves David Sedaris’ account of his experiences with Socialized Medicine in the heart of Old Europe.

American Humorist David Sedaris

This week’s New Yorker Magazine has a hilarious piece by humorist David Sedaris.  Mr. Sedaris now lives in Paris and I squeal with delight every time I read one of his essays on his French experiences.   Here is his take on French medicine.  This is just an excerpt and you  should really pick up the April 2, 2012 New Yorker to read the entire essay. 

I was lying in bed and found a lump on my right side, just below my rib cage.  It was like a devilled egg tucked beneath my skin.  Cancer, I thought.  A phone call and twenty minutes later, I was stretched out on the examining table with my shirt raised. 

 “Oh, that’s nothing,” Dr. Medioni said.  “A little fatty tumor.  Dogs get them all the time.”

I thought of other things dogs have that I don’t want:  Dewclaws, for example.  Hookworms.  “Can I have it removed?”

“I guess you could , but why would you want to?”

He made me feel vain and frivolous for even thinking about it.  “Your right,” I told him.  “I’ll just pull my bathing suit up a little higher.”

When I asked him if the tumor would get any bigger, the doctor gave it a little squeeze.  “Bigger?  Sure, probably.”

“Will it get a lot bigger?”


“Why not?” I asked.

And he said, sounding suddenly weary, “I don’t know.  Why don’t trees touch the sky?”

This conversation would never happen in my office.  The conversation would go something like this.

Me:  It’s probably a lipoma, a fatty tumor.  They are very common.  (I’d leave the dog reference out).  It could be something else but I am almost certain it’s a lipoma.

David:  Can I have it removed?

Me:  Sure.  I would send it to pathology to make sure it wasn’t something more serious and that would take care of it.  These lipomas can get pretty big.  I could remove it next week in the office.  I would inject some local anesthetic and remove it though a small incision.  You could drive yourself home.  It will leave a scar but the scar won’t be as noticable as the lipoma.

David:  Will my insurance pay for it?

Me:  Maybe, it depends on your insurance.  I’ll have you pay me, then I will send the information to your insurance company and they might reimburse you. 

David:  How much will it cost?

Me:  I’ll have my patient care coordinator give you a price quote and get you on my schedule.  Make sure you don’t take any aspirin between now and next week

So here’s the difference:  I’m happy to take the lipoma out.  I like doing surgery and that’s how I pay my bills.  Also, I want to make sure it is a lipoma.  If it is something horrible like a fibro-fatty cancerous horrindoma and Mr. Sedaris has a delayed diagnosis because of me, he will sue me for a bazillion dollars.   I, like all American doctors, practice defensive medicine.   In America, defensive medicine is the standard of care.  Also, this conversation takes place between two Americans.  American patients  like to get things fixed and American doctors like to fix things.   Even minor things.  So there will be about $500 changing hands because of Mr. Sedaris’  lipoma, $250 for the use of the operating room and $250 for my time and skill.    In France, $50 changes hands because  Dr. Medioni is dismissive about Mr. Sedris’ lipoma and is not worried about being sued even with the 0.1% chance his clinical impression is wrong.  And  Mr. Sedaris lives with his lipoma and pulls his bathing suit up a little higher. 

This, folks, is why American Health care is so expensive.

Thanks for reading!  Dr. Lisa Lynn Sowder


General Health, Government and Politics, Health Care Costs, Plastic Surgery, Uncategorized

The truth about breast surgery in the obese patient

November 4th, 2011 — 12:01am

Seattle Plastic Surgeon tells it like it is for obese women seeking breast surgery.

A recent article published in The Journal of Plastic & Reconstructive Surgery caught my attention.  This article looked at breast surgery outcomes in  7982 patients (that would be almost 16,ooo breasts!!!!) and divided the patients in obese and non-obese.  Their results were not surprising to me but they may be surprising to you.  The obese patients had a nearly 12 fold increase in postoperative complications when compared to non-obese patients.

Breast reduction is the most common breast operation performed in obese women.  That operation has a nearly 9 fold increase in postoperative complication in obese women compared to the non-obese.

This is not news for those of us who do a lot of reductions.  The sort of problems that obese women tend to have are fluid  collections (seroma), bleeding, delayed healing and infection.  These complications sometimes require a trip back to the operating room and they always require many, many postoperative visits.  Despite a rocky postoperative recovery, many obese women are still glad they had a reduction after everything is healed up.

So what’s the big deal?  All’s well that ends well, right?    Let’s look at this from an few different points of view.  If insurance pays for the reduction, they don’t want to see more bills for a hospital readmission to stop postoperative bleeding or a bajillion office visit bills to treat an infected wound.   And insurance companies are looking more closely at surgical outcomes and costs and using this information to rate surgeons.

If the reduction is private pay, the surgeon is unlikley to bill for increased postoperative visits which can run into 10 – 20 additional visits during recovery.  This can get very time consuming and expensive.

And for the patient it is no picnic having to pack an area along the suture line that either became infected or fell apart.  Post operative complications are just a total bummer all around, especially when the surgery is totally elective.

And here another issue.  Let’s say an obese lady has 5 pounds of breast tissue (which is 99% fat) removed and her weight drifts back up to her preoperative weight which almost always happens.  This means that she has gained 5 pounds of fat.  If that fat is just external fat, say on her hips, it’s not a big health issue but if it is intraabdominal fat a.k.a. belly fat a.k.a. visceral fat, it is a huge health risk.  Her breasts may no longer be killing her neck and back but her belly fat may literally be killing her.

So what am I really trying to say here.  Obese patients need to understand that breast reduction has a high rate of complications and that a reduction may actually make them less healthy if they gain back their weight as belly fat.

So this is a real sticky wicket.  Obese reduction patients are usually helped with back and neck pain with a breast reduction but weight loss would also help those back and neck pain issues.  Non surgical weight loss has no surgical risk and is accompanied by a host of improvements in a patients health.  Think high blood pressure, type 2 diabetes, arthritis, high cholesterol, etc.

So if you are obese and want a breast reduction from me, you will get a little weight loss lecture from me and may get turned down for surgery until you are able to shape up and slim down a little.    You may be willing to accept a high risk for a postoperative complication but I may not be.

Thanks for reading.  And if you have a quick, easy way to lose weight, please let me know.  I’m all ears.

 Dr. Lisa Lynn Sowder

Body Contouring, Breast Contouring, Breast Reduction, Health Care Costs, Obesity, Postoperative Care

Groupons for plastic surgery? Nope and here’s why.

July 27th, 2011 — 7:22pm

Hip Seattle Plastic Surgeon does not offer Groupon for services.  Shocking, huh?

Groupon for medical services is considered fee splitting and it’s illegal.

I know, I know – Groupon is just the best thing since sliced bread but you won’t be finding it in my office, at least not until the laws change.

Yeah, it would be kinda fun to get a bajillion people to give Botox a try so they can see how fabulous it is and maybe turn them into life long Botox patients but the downside for me is that it is illegal.  You see, when a person buys a Groupon, the Groupon folks take a cut and that cut is called fee splitting and for medical services, it’s illegal.

The law does not look at this any differently than me paying another doctor for sending patients my way.  That sort of bad doctor behavior is taken very, very seriously.

So Botox Groupons just isn’t going to be something I offer.  Although, I would likely get some much needed rest behind bars, I think my family and my practice might miss me.

Thanks for reading!  Dr. Lisa Lynn Sowder

Government and Politics, Health Care Costs

Canadians Saving Health Care Dollars

January 13th, 2011 — 9:50am

sc00001fbaSeattle Plastic Surgeon Comes Across a Very Interesting Article in a Canadian Journal

I was cleaning my desk this morning (that’s a few blog entries in itself) and stumbled upon an article I has saved from a 2006 issue of the Canadia Journal of Plastic Surgery. This article compared the sterility and cost of “sterile wound dressings” and more common absorbtive items such as panty lines, sanitary napkins and disposable (duh) diapers.

Not suprising was the cost difference with the common items being a fraction of the cost of “sterile wound dressings”. For example, one month supply of panty liners cost $2.43 vs. $16.50 for one month supply of sterile dressings. The surprising finding was that the common items were as sterile as the “sterile dressings”. A small percentage of all items tested grew various common bacteria when cultured.

I have been recommending panty lines or sanitary napkins as dressing to my patients ever since I first read this paper. They look at me kind of funny and are always a little shocked when I refer to this article. Maybe this is why Canadian health care is so much less costly that ours???

General Health, Health Care Costs, Now That's a Little Weird, Plastic Surgery, Postoperative Care

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