How One Couple Saved Over $34,000 with Medical Tourism
Now they reveal everything they learned.
Note: Tom and Georganna will do a livechat Q&A on this topic on Tuesday, July 5, 2022, at 3 PM ET. Join us here to have your specific questions answered.
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Tom Swan and Georganna Hawley are two friends of ours who became digital nomads a little less than a year ago. But even before they left the United States to travel the world, they knew Tom needed bilateral knee replacement surgery.
The plan was to do “medical tourism” — travel to another country for medical treatment — to get Tom’s surgery done for less than what it would cost in the United States.
Total cost in the U.S.? About $120,000. Even with insurance, they would have had to pay over $50,000 in assorted costs.
In the end, they spent about $16,000 having the surgery done in Istanbul, Türkiye (formerly “Turkey”). That’s a savings of over $34,000, and they don’t think they sacrificed anything in terms of quality of care.
In this interview, Tom and Georganna share the details about the experience: how they came to choose Istanbul for the surgery; specifics costs; insurance details; and a treasure trove of other insights and advice.
Michael: Thanks for sharing your experience with us! What was Tom’s medical condition that led you to look outside of the U.S. for treatment?
Georganna: Tom suffered from knee osteoarthritis (OA), which meant that all of the cartilage in his knees had worn away, and he needed a bilateral knee replacement.
Michael: Tell us about trying to get your knee replacements in the U.S.
Georganna: At home in Ventura County, California, our healthcare insurance was Kaiser Permanente’s 70/30 plan. That means Kaiser would pay for seventy percent of the costs, and we would pay thirty percent of all expenses after the deductible. The deductible was $7,500.
Tom knew years ago he needed the surgery, but Kaiser had been refusing to authorize it, saying the problem wasn’t bad enough yet. Finally, Tom realized they were waiting until he reached Medicare age, when Medicare would pay eighty percent and either Tom or his secondary insurance would pay the other twenty percent.
During the last ten months, his pain was fairly low to moderate (three to four on the ten-point pain scale), but constant, even when at rest. He took 600-800mg of Ibuprofen per day just to get by. Stairs were to be avoided, and in Europe this can be an obstacle to going many places. Just getting up and down the stairs on a train was sometimes nearly impossible. Our preferred mode of exploring is by walking, and our ability to maximize our day was severely limited by the amount of walking he could endure.
We found the situation untenable.
Michael: What was the cost of the surgery in the U.S.?
Georganna: Total cost of knee replacement surgery in Southern California is currently about $60,000 for one knee. For two knees that’s $120,000. Tom’s portion of that would have been about $36,000 plus the $7,500 deductible, plus monthly insurance premiums at $650 a month.
Then there are additional expenses not fully covered by insurance, like medical equipment, rehabilitation, and more. There are tons of things American insurance companies won’t pay for that you still need, but you don’t know that until it’s too late.
If Tom had had the surgery in the U.S., we estimate the costs would have been $43,500, plus the insurance premiums of $7,800 per year. So in the best case scenario, total costs of over $51,000.
Michael: What happened once you realized how expensive it would be in the U.S.?
Tom: A couple years ago, we started to explore options. One option was to change insurance carriers. But changing carriers would have meant still paying as much as thirty percent of the total cost out of pocket.
So we started looking at medical tourism.
Michael: Tell us about the research you did and how you came to settle on Türkiye. What were your other choices? How did costs compare?
Tom: We both did extensive research into the countries that are known from medical tourism, especially knee replacement surgery. Those countries include Colombia, Türkiye, Mexico, Viet Nam, South Korea, India and Malaysia.
We tended not to rely on paid advertising articles, but we did watch a number of YouTube videos made by people who had been through the surgery abroad, as well as news-type and interview articles.
Although we understand total costs can be somewhat less in Southeast Asia, I’m not yet comfortable enough to go there. We wanted a place we felt we knew. Mexico was a strong favorite for a long time, but the general level of violence in Mexico was a concern. And in Colombia, the cost is very low, but didn’t seem safe enough in my opinion since Georganna would have to be going out a lot without me.
Georganna: Türkiye was always high on the list because we spent two months there at the beginning of the year. We like the people and pace of life, and especially the food. Most importantly, I felt safe navigating there alone.
In early February, we told our Türkish friend Yasmin about Tom’s need for knee replacement. She’s looking to open a business as a medical advocate, and she arranged for us to meet at the end of the month with Drs. Serhat and Harun Mutlu, two Türkish brothers who worked together as a team. They confirmed that Tom’s knees were abrading bone on bone with no cartilage remaining. The only effective, permanent treatment is knee replacement surgery, which they recommended doing simultaneously.
As we already mentioned, U.S. insurance companies have an approval process that can be very slow and not at all in the patient’s best interests. Approval in Türkiye was only determined by the surgeon and the hospital’s schedules. We could have had it done within the week if we had wanted.
Michael: Can you explain the role of a medical advocate and what they provide?
Georganna: As I said, ours was a personal friend, not someone we hired.
That being said, we are in awe of the work Yasmin did for us, and we absolutely recommend getting an advocate to help you. She found the surgeons through her extensive network of friends and family, made our consultation appointment, and escorted us to the initial consultation and X-ray facility. She kept Tom apprised of the pre-op admission schedule, arranged for our transportation to the hospital, and has kept abreast of his hospital stay and progress at home.
Michael: Tell us about the hospital. I think a lot of Americans might have misconceptions about foreign hospitals, especially in a country like Türkiye.
Georganna: The quality of care in many foreign countries is extraordinary, and Türkiye is no exception. We had the choice between two modern, private hospitals, and we chose Medical Park Hospital, which our two doctors are affiliated with. Both are private facilities in central Istanbul, and Medical Park was about $10,000 less than the other choice. When we asked what the difference was, it seemed a matter of luxury rather than quality of care. We still had private nurses assigned to us, as well as the regular floor staff.
Interesting note: We never saw a piece of paper after Tom signed the admission documents. All charts were on the nurse’s phones. They just entered your blood pressure, or noted what meds they gave you on their phones, and it was available digitally to the doctors and other nurses.
Michael: Tell us about the day of surgery. Did you have to sign a document releasing them from responsibility if anything went wrong? How long did the surgery last?
Georganna: We signed two or three admittance forms in Türkish at the hospital, and that was about it.
One of the reasons we wanted to be out of the U.S. medical system is the litigious nature of it, as well as the tyranny of insurance hanging over every procedure. Here they just do their job to the best of their abilities and don’t worry about getting sued by every patient. They are very well trained. In fact, one of our doctors is an associate professor of surgery at an Istanbul university.
Surgery was scheduled to last three to four hours, and Tom was in recovery within three hours, and back in his room in four and a half hours. Both doctors accompanied him out of recovery and saw that he was properly settled. They also visited him every morning and late evening.
Late one evening, we told them the hospital walkers were too short, and the toilets were too low for Tom. They called a medical supplier, and all the needed equipment was delivered to his room by one A.M. that night!
Michael: This is a country where you don't speak the language and aren't a legal resident. Did you feel extra anxiety before surgery because of these aspects?
Georganna: Major surgery is a scary proposition no matter where you are, but our worries were mostly misplaced. Although in one instance we tried to get a pre-surgery prescription filled with just a digital copy on our phone. The pharmacy insisted on a “wet” signature. Oh no! But, after a short phone conversation with Yasmin speaking to the pharmacist, we left the store with a filled prescription in hand.
The language barrier is real, but not as high as one may think. Some hospitals may have English-speaking translators, but the logistics of them being there when you need them can be tricky. You can also hire a personal translator for all or part of your procedure. The cost of that will figure into your budget [but it will be very reasonable in a country like Türkiye, where wages are much lower].
But many key people speak at least some English, and Google Translate works very well, both as text and as a spoken word translator.
Tom felt a lot of apprehension about what was actually involved. After all, he was replacing parts of his body with titanium. And he had been warned how painful post-op and then rehab would be. There was some initial anxiety about having surgery done in another country, as we Americans are all taught that the U.S. is superior in all things. But we’ve learned after twenty years of travel that this is not necessarily true. In the end, he was actually more confident having the surgery done outside the U.S.
Tom: Georganna had her own apprehensions, of course. However, seeing the pain I was in walking every day, climbing stairs, negotiating cobblestone streets of Europe for the past ten months, she was convinced this was the only recourse to a pain-free mobility for me. She's blessed with a number of good friends who had gone through this very procedure and their joy at living pain-free was her beacon of hope.
Michael: What legal avenues of recourse did you have if something had gone wrong?
Tom: To be honest, this was not a big part of our considerations. Perhaps it should have been, but we knew that we had to place our trust in the doctors here, as you would anywhere. This surgery is not experimental and has a very high success rate. We had confidence in our choice.
Meanwhile, the idea of trying to get this done in the U.S. was quite frankly overwhelming. Months of trying to get our primary care doctor to give referrals to specialists, having to wait for approvals, waiting for a surgery date, arranging for physical therapy on our own, all these things were just too intimidating.
We had none of that here.
Michael: Recovering from knee surgery requires a lot of physical therapy and rehabilitation. How has that worked?
Georganna: This might be a good place to share a breakdown of our total package.
It included pre-surgery admittance with the surgeons’ assistance; surgery on both knees performed by two surgeons at the same time, which is not the norm in the U.S.; American-made titanium parts; an anesthesiologist; four nights in a private room, including a bed and meals for Georganna; 24-hour private nurses in addition to the regular floor nurses; all drugs, tests, and use of rehab equipment while in the hospital and at home; post-op x-rays; drugs for recovery at home; and ambulance ride to our apartment.
In terms of physical therapy, the package came with six physiotherapy visits (including four house-calls) with an English-speaking therapist who has twenty-three years of orthopedic experience. We also had two doctor house-calls, which, as Americans, seemed almost inconceivable. Plus, a knee flex machine for use in the apartment.
All of that came to exactly $16,000 USD, or about one third of what the surgery would have been in the U.S. [with insurance; without insurance, it would have cost at least $120,000, probably a lot more given all the hidden costs that American insurance companies won’t pay].
Physical therapy is tough, no getting around it. Each day, Tom has two or three sessions doing painful bending and leg lift exercises, uses the mechanical flexing machine three times daily, and walking, walking, walking. It’s now seven days after surgery, and he has largely abandoned the walker for two canes and is preparing for work on stairs in the next few days. He was given pain meds, but they are mostly unused so far. He is back at his computer as usual, servicing clients. And playing guitar again.
Michael: Were there any other expenses?
Georganna: Our out-of-pocket expenses included a higher and heavy-duty walker, because Tom is so tall, as well as a higher pair of canes; a toilet seat booster as European toilets are often very low; a chair-type portable toilet; two kilogram ankle weights and special orthotics for Tom’s shoes.
All of that came to a total of $256 USD.
The use of hospital equipment for the duration of physical therapy was included in the package, but he needed this special equipment due to his height. We plan on donating that equipment to a public hospital or nursing home when we are done.
Pre-surgery expenses totaled $311 USD for the original consultation; X-rays at the time of original consultation; and collagen injections in each knee for immediate pain relief in February.
We still need to pay for the car, driver, and translator for the day before surgery, of course, as that was out of Yasmin’s pocket. We expect that to come to under $100 USD. But almost everything else Yasmin did was as a friend, though she is planning on opening a business at some point.
We were very fortunate to have Yasmin. I’m not exactly sure what her services would cost if she weren’t a friend, but I would guess it would be in the range of $500 USD. That figure is based on comparing it to the breakdown of surgeons, anesthesiologists, and so on. Still a guess. But even if we add an additional 20% to the total cost the final amount the total would still fall under $20,000.
That is less than half of what our costs would be in the U.S.
We think anyone wanting to proceed with surgery in another country would be wise to arrange for an advocate or medical tourism service provider, and to have a contract with everything spelled out.
Michael: Did you need to get a special medical visa or was a tourist visa enough time for the recovery?
Tom: We knew we could be in Türkiye on a regular tourist visa for 90 days. We arrived back in the country just a few days before surgery so we could be here for as long as the estimated recovery time. There is a way to apply for an extended visa for medical reasons in Türkiye, but every country will have different criteria.
Michael: What sort of steps did you take ahead of time such as figuring out where to live during Tom’s rehabilitation, how you’d shop for food, and those sorts of things?
Georganna: We definitely think you have to consider the city you’ll be in differently than if you are going as a tourist. You want it to be easy getting around using metro/trams/bus/Uber. This is not a five-day guided tour. You will be living here for weeks if not months.
We also think you should spend a week or so before your procedure where you’ll actually be staying post-op. Are there any cooking/housekeeping items missing? Is there a comfortable couch/chair?
Scope out the neighborhood where you will be staying. Is it quiet at night? Is there a lot of traffic? What is the condition of the streets and sidewalks? In many cities in Europe, it is normal to park cars on the sidewalk. Tom will have to practice walking outside, but it shouldn’t have to be an obstacle course while he is doing it.
We got a nice Airbnb in a high-rise on the north outskirts of Istanbul for $3,000 a month, about fifteen minutes by taxi from the hospital. It's close to a tram line, walking distance to the restaurants, a grocery and pharmacy, and a short Uber ride to the Mall of Istanbul for specialty shopping. Our condo has an elevator, a washer, a full kitchen, and a small gym. The cost is a bit above our normal nomad budget, but amenities were critical in this case.
Tom: We chose Türkiye because we feel safe with Georganna going out by herself to do shopping and run errands within walking distance, and to have some time to herself.
Michael: Any other pre or post-op advice?
Georganna: Get to know where all the necessary stores and services are. Find the metro/tram/bus stops closest to you and get paid rider cards. Have Uber/Lyft/Bolt apps on your phones. Install a food delivery app on your phone as well.
Unless you’re using something like Google Fi or T-Mobile, buy local SIM cards and install them before you need them. If you don’t have it, install WhatsApp on your phones. Literally everyone in Europe uses it, and everyone you meet, including your doctors, will want to communicate that way.
We know some people have done this kind of thing alone, but we found having a partner to be essential. Whether it’s a spouse, adult child or friend, they will be another advocate during your hospital stay. They will need to learn how to do your physical therapy, help you get up off the toilet, and the list goes on.
It helps if you have a shared goal or reward for when this is over, a fun trip you have been putting off, or maybe just a week at a spa.
What's been the best part of the process? What about the worst?
Georganna: The worst part was seeing my husband in pain for months. The first few hours after surgery were not too much fun, but seeing his strength and mobility improve every day is wonderful.
Tom: For me, the worst part was the initial pain after surgery, which I was warned about. I’m glad I did both knees at once as I wouldn’t want to go through this again.
The best part has been the seamless nature of the process, much of which is due to Yasmin, and the complete package offered by the doctors.
How has Tom’s recovery been and how is he doing now?
Georganna: It’s only been seven days, but it’s going much better than we had anticipated. It is a lot of hard work on Tom’s part, of course.
Tom: Georganna has quite a bit on her shoulders too, helping me, doing the exercise sessions with me, administering medications, and all that. Plus she’s doing all the everyday tasks we usually share.
But things are getting better surprisingly quickly.
Michael: How do you now view the U.S. healthcare system?
Georganna: Although I’m still paying for Medicare, we now intend to avoid the U.S. healthcare system at all costs. Now that I have seen how successful and stress-free medical care is in Türkiye, I am confident to use available care in other countries as we continue to nomad.
Tom: I think that the healthcare system in the U.S. is completely broken and has been for a long time. As long as the insurance industry continues to have a stranglehold on our healthcare system, it will remain broken.
Michael: Anything else you think folks considering medical tourism should know?
Georganna: Do your research. Make a plan. Get on the plane.
Note: Tom and Georganna will do being a livechat Q&A on this topic on Tuesday, July 5, 2022, at 3 PM ET. Join us here to have your specific questions answered.
To make sure you don’t miss the chat, you can sign up on Facebook by clicking this link and have a reminder sent to you.