Joint Venture

Candase Chase

The Daily Inter Lake

For Somers man without health insurance, knee surgery in Thailand was just what the doctor ordered

Greg Macker, 43, of Somers remembers the moment his knee popped in midswing at Buffalo Hills Golf Club.

"I was on the 10th hole," he said. " I was taking a shot from the fairway."

He felt a snap like a rubber band in his right knee. Macker was concerned because he knew he had only 20 percent of his anterior cruciate ligament - which helps stabilize the knee - remaining after a skiing accident about 12 years ago.

At that time, the owner of a Christmas tree wholesale/retail business had health insurance that paid for arthroscopic surgery.

Macker said he was able to finish the golf game in November 2005, but he worried about the injury.

"In my mind, I knew I tore a little bit of it," he said.

But Macker had dropped his health insurance when the premiums shot up from $75 a month to $225, choosing to pay out-of-pocket for yearly exams and blood-pressure medicine.

kkellogg 11/16/06 Calculating his deductible and 30 percent co-pay required with his former coverage, he came out ahead financially for years. As a genuine free spirit, Macker has never been adverse to risk taking in any area of his life.

"I've always been self-employed," he said. "I'm kind of proud of that."After the November incident with his knee, he got a severe case of sticker shock when he priced an ACL repair in the Flathead Valley: $20,000.

Instead of seeking treatment, Macker buckled on a knee brace and continued skiing and traveling. Yet, in the back of his mind, he knew his fragile knee might threaten his business and the athletic lifestyle he enjoyed so much.

Then one Sunday, he found the answer while relaxing in his La-Z-Boy watching a "60 Minutes" segment about uninsured Americans saving big money by traveling overseas for surgery.

"It was amazing," he said. "There was a guy who needed a triple bypass but he had decided he'd rather die than spend $150,000 on the operation."

The patient found another option at Bumrungrad International, a world-class hospital in Bangkok, Thailand. The man got his triple bypass for $15,000.

"I said that's just what I need," Macker said.

He went on the Internet, found Bumrungrad, and began reviewing surgeons and their credentials, which led him to Dr. Mason Porramatikul. The doctor is a Harvard graduate, and Macker liked that.

"Plus, I liked his smile," he said. "He looked like a real friendly doctor."

Macker sent Porramatikul an e-mail with a description of his problem. The surgeon replied with a price of $1,500 for a relatively simple procedure or $3,500 if the tendon required repair.

Nearly everyone he knew tried to talk him out of his decision to travel to Bangkok in March. But Macker, confident with the hospital's international accreditation, decided to dip his toe in the new wave of medical tourism.

kkellogg 11/16/06 After traveling to Florida to visit his parents, he boarded a plane in March for 22 hours of flying to Bangkok with an interim stop in South Korea. His ticket, purchased through Travelocity on the Internet, cost $1,080.

Macker laughed as he recalled the entry he put in his journal as he landed in Bangkok. He wrote "the chaos and confusion" starts now.

kkellogg 11/16/06 After a rocky start with a non-English-speaking cab driver, he managed to arrive at his hotel with translating help by two ladies of the evening. After three days of sightseeing, he walked into Bumrungrad International for his initial appointment with Porramatikul.

The surgeon determined that he needed a $3,500 ACL repair. Assisted by eight registered nurses, the physician quickly ran

Macker through tests to assure his fitness for surgery.

Macker picked a surgery date for five weeks later because he planned to tour Southeast Asia. During those five weeks, he toured Burma, Laos, Cambodia and Vietnam.

"I went white-water rafting on the Mekong River," he said.

Macker arrived promptly at 6 a.m. at Bumrungrad to begin his adventure in foreign medicine. He admits to misgivings as he was prepared for the procedure.

"As you go into surgery, you realize you are all alone in a foreign country," he said with a laugh. "No one's going to be there to say 'Hey, how are you doing' afterward."

Macker opted to stay awake to watch his knee procedure. He watched for about a half-hour as the orthopedic surgeon hammered and drilled holes.

"I could feel the vibration," he said. "I watched it pop through the bone."

Eventually, he asked to go to sleep. At 9 a.m., he woke up in Ritz-Carlton-like hospital room, complete with a leather sofa, marble counters, refrigerator and balcony.

He was feeling no pain thanks to the morphine drip; instead, he was flooded with relief. The next day he returned to his hotel, where he stayed for 10 days while receiving physical therapy.

"I should have stayed another week," he said on reflection. "It was a long plane ride with my leg."

But Macker has no regrets, particularly when he added up the tab for the operation, transportation and six weeks of touring. At just $6,500, he figured he paid only $500 more than he would have paid for the deductible if he had the operation with insurance coverage in the Flathead.

Although he has very little scarring, Macker said he faces a year of cutting back on athletics to make certain the ligament has healed. He recently had his knee checked by a local orthopedic surgeon, who said everything looked good.

"I'd recommend it to anyone who doesn't have insurance," he said. "Why live in pain?"

Reporter Candace Chase may be reached at 758-4436 or by e-mail at cchase@dailyinterlake.com.