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Shocked by "sticker price" of biopsy

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Posted 11/10/2010 2:45 PM (GMT 0)

BillMac said:  "I mean after all, they can only manage to deliver to their populace a significantly higher life span, and a very noticeable lower infant mortality rate than the US and manage to do this at a much lower cost. Meanwhile many of those countries deliver these results with (shock! horror!) universal health schemes shocked smilewinkgrin "

The problem is, many other countries don't compute their successes and failures the same way we do here in the States.   When we talk about infant mortality here in the States, we count everything.   Other countries use different data reporting sytems.  When these differences are removed, our healthcare system reveals itself as one of the best in the world.  See http://badtothebohn.wordpress.com/2010/04/19/how-does-the-infant-mortality-rate-in-the-us-compare/

It's easy to make yourself look good if you don't report your failures.  Our media seem generally too lazy to report these variables, or too concerned with promoting universal health care as an agenda item.

Posted 11/10/2010 3:12 PM (GMT 0)
Let's not wander into the ditch with our discussion of biopsy costs. The manner they are paid and the health system used is a Rule violation once 'discussions' begins comparing them and criticizing/arguing/etc. Extended Politico-medical discussions are a violation, sorry. Member support only.

. Rule 11:

11. No posts of an overtly political or religious nature OR posts promoting advocacy of particular personal, medical, legal, religious, political, or non-profit causes. The forums are intended for offering mutual personal support. Debating controversial subjects should be taken elsewhere. Limited religious references are allowed (ie. "my prayers are with you" or a brief quote as part of a larger post), but the forums should not be used to convert others.
Posted 11/10/2010 3:32 PM (GMT 0)
OK, sorry, but the issue was raised earlier without objection. More to the point, my biopsy costs were comparatively high.  The original biopsy pathology report bill was $4590.  The uro charged $4150 for the biopsy procedure  The insurance approved $3755 total for those costs.  Start to finish my billling costs for diagnosis, testing, biopsy, and surgery were in the 90K range.  I guess I just happen to live in a high cost area. Still, out of that $90K total billing, our out of pocket expenses were in the 3K range, which isn't too bad, I guess.  Everything that took place after Aug. 13th, when I turned 65, was negotiated way down by the insurance company.

Posted 11/10/2010 4:30 PM (GMT 0)
clocknut, from what you are saying, out of the 90k total, you paid roughly 3 1/3rd% out of pocket, by most peoples standard here in the US, that would be considered very good.
Posted 11/10/2010 4:55 PM (GMT 0)

clocknut said...
Still, out of that $90K total billing, our out of pocket expenses were in the 3K range, which isn't too bad, I guess. 


Clocknut, two comments:

  • Your "$90K total billing" sounds very close the costs billed to insurance for my total experience starting with biopsy and ending my overnight hospital stay after surgery; no complications.
  • One's personal out of pocket amount will vary depending mostly on the type of private medical insurance one selects.  With most private medical insurance, one can elect to pay a lower premium on a monthly basis (a often overlooked component of cost, but included in one's total compensation) and have a higher total out of pocket annual limit, or one can elect to pay more on a monthly basis and have a lower total out of pocket annual limit.  Another dimension is the rate of contribution of one's employer.  These factors make a meaningful comparison difficult, and meaningless to compare just one of the dimensions.
Posted 11/10/2010 5:06 PM (GMT 0)

You're absolutely right, David. The hospital billed 51K but were paid only about 7.5K for a 3-day stay, and our out of pocket for the hospital stay was limited to $200.  I don't see how they could pay their staff and make a profit at that rate. 

We're almost embarrassed how llittle the surgical assistant, the anesthesiologist and the nurse anesthetist were eventually paid.  They ended up making less than $100/hr. for their part, which may sound like a lot, but surely isn't sufficient to pay for their malpractice insurance and other overhead.  The surgeon was paid about 2K for a four-hour surgery.  These are the guys who held my life in their hands.

Again, I think these payments were so low because after I turned 65 just one week prior to surgery, my insurance prohibited them from billing me more than they would bill a Medicare patient (even though I hadn't yet applied for Medicare).  Had they looked at my file, found my birthdate, and operated 8 days earlier, they would have made a lot more money.

By the way, the pathologist got $500 more for reading the biopsy pathology than the uro got for performing the procedure.  I think I'd rather be the pathologist than the guy with my hands in someone else's caboose!

The biopsy and all the other pre-surgery testing received higher rates of reimbursement because I was still 64.

Casey, I think you're also in the greater Chicago area, so maybe that explains our similar cost figures.


Post Edited (clocknut) : 11/10/2010 10:09:53 AM (GMT-7)

Posted 11/10/2010 5:50 PM (GMT 0)
I have no complaints about ouir BC/BS either, in S.C., its considered the insurance carrier to have, even all the State Employees are on it, and as a patient, if you have it, never have any troubles with them accepting it up front without question. Even with the home nurse care, in home physical therapy, and the oncology dietician supplied by my hospital recently, never even talked about money, nor did I even have to pay a single co-pay. Feel fortunate there.
Posted 11/10/2010 10:24 PM (GMT 0)
Hello Casey59,

Thanks for the input...that is over one thousand dollars less than what I was quote. I am hopeful that I will be able to work something out with Bostwick as well as find an urologist that peforms the biopsy in his office.


Happy Birthday!
Posted 11/10/2010 10:32 PM (GMT 0)
Hello to all,

I want to sincerely thank you for all the input... I was discussing with my wife how technology has changed our lives for the better in many cases and this forum and the people who contribute to it are a perfect example.



Best wishes to all
Posted 2/1/2011 12:19 AM (GMT 0)
I had my second biopsy in the last 9 months. This one was 24 cores after seeing my PSA go from 0.8 to 7.7 over the past two years. Both biopies came back negative, but talking about sticker shock...I looked at my insurance claims yesterday and the pathologist had billed $11,808 for the tissue analysis. Insurance allowed all but $21 of the charge and paid $9900, leaving me with a $1900 co-insurance bill. I've ask the insurance company to look into this as I couldn't believe it was possible for it to be correct.
Posted 2/1/2011 1:02 AM (GMT 0)
I'm not surprised. My insurance would only pay for 6 cores. Fortunately, and much to their credit in my mind, Bostwick wrote off the other 6 (of 12 total.

But it all went against deductible and out of pocket (like most now, I have an extraordinarily high deductible now).

Posted 2/1/2011 2:19 AM (GMT 0)
RGPinRR--

The pathologist billed $11,808 just for the analysis??!!! That is outrageous!

I think the pathology part of my biopsy was around $300 (for a 12 core)

I think the whole cost of the biopsy including the procedure in the doctors office was around $1100, including the Uros fee.

Let us know what you find out.

Dan
Posted 2/1/2011 2:47 AM (GMT 0)
RGP,
Did you have a saturation biopsy with general anesthesia? Because if you had a standard 12 or 16 core biopsy you need to contest that bill, through arbitration is necessary. I have helped a few guys through this process and typically it's around 3K for the whole shabang. Medicare only pays $1,800.

Something is rotten here.

Tony
Posted 2/1/2011 3:38 PM (GMT 0)
RGP,

I looked back and checked the prices. I had posted the total for my 12 core biopsy in 2009 - it was just at $6900 total, lab, doctor and the like all included.

For the pathology part, the original bill was just under $3000 for the 12 cores.

What insurance actually paid is a whole different story.

Posted 2/1/2011 5:25 PM (GMT 0)
I am in Atlanta. My urologist does the biopsies in-house as they have 6 uros in the group. They have a PA-C that does the biopsies and has been aspecialist for more than 20 years. He does several a day. They only use Bostwick for the reading. My insurance paid about $1,200 for the biopsy procedure and $600 for the pathology.
Posted 2/1/2011 6:06 PM (GMT 0)
In a separate thread, we're again suggesting that a newly-diagnosed person get a second reading on his biopsy pathology. Does anyone know if most insurances pay for a second reading of the slildes? If not, the amount of money we're talking about can certainly become a problem for many families. As I said earlier in this thread, the pathology after biopsy was one of the most surprisingly high costs we encountered.

Also, I'd be interested to see how often the numbers change when re-read by one of the "premier" sites to which we often refer people. And is it appropriate to even suggest that a lot of uro-docs use inferior pathologists because of some "good old boy network"? I would really like to see some proof of that, 'cause I just don't believe it, and newly diagnosed have enough anxiety without injecting needless worry about the doctor's motivations.

Unless there's some reason to believe that a lab is doing shoddy work, I'm not convinced that a second reading is needed in every case.

I've seen this advice so often of late that I'd really like to see some statistical evidence to justify the blanket suggestion for second readings. I even wonder if most labs don't already do a "double check" on any slides which fall into the "borderline" areas. I can envision Pathologist "Charlie," saying, "Hey, Pathologist Joe, this shows signs of "3" and "4," what do you think?"
Posted 2/1/2011 6:52 PM (GMT 0)
Several points to touch on clocknut,
First every pathology report I have seen, and that's quite a few, has a primary pathologists and a secondary pathologist reviewing the slides. But it may be only a cursory 2nd review. Taking the slides to a known source is mostly for confirmation.

My second opinion was covered by my insurance. However, for those with challanges...When I met David Bostwick he pointed out that Bostwick has a program for those self paying for their 2nd opinions. Here is a link for it:

/www.bostwicklaboratories.com/global/patients.aspx

I would agree with you that most labs do a good job. The problem is that you really don't know anything about the lab that reviews the slides. And since you are making decisions based on that pathology result that could affect you for the rest of your life ~ $500.00 to $1,000 spent on a review is not bad money. I have only seen a change a few times when the pathology was reviewed by Epstein, even less by Bostwick. But two of the guys that did it did in fact change their approach with the new results. One was downgraded to Gleason 6 from 7, the other was the opposite. One appeared to be an active surveillance guy and wasn't, and the other elected to slow his approach because it was not a Gleason 7.

Pathologist "Charlie" might be very gifted and doing a great job. Bostwick and Epstein LIKELY are doing a more thorough review. If all agree, then the decisions may become easier.

Tony
Posted 2/1/2011 7:01 PM (GMT 0)

Good points, Tony, esp. the one about Bostwick. 

What happens, though, when the slides are reviewed and the two don't agree.  Does it make sense to automatically trust the second opinion over the first, even if done at a big-name lab.  So now do we get a third reading and go with two out of three? 

If my local lab says Gleason 7 and Bostwick says, no, it's Gleason 6, I wouldn't view that as a reprieve. My personal reaction would be to accept the worst case scenario, just to be safe.  I'm not psychologically well suited for AS.   I'd probably be seeking treatment anyway, and the debate over 6 or 7 would be academic.

Posted 2/1/2011 7:16 PM (GMT 0)
Good questions clock.

And you raise a good point. If they are different, I would lean more to the one everybody knows about. But you really have to ask yourself if either being correct would it change your decision? I have seen a G8 changed to a G9 ~ either way most will elect to treat the disease. They may change their approach but seldom likely. Additionally, many would side with you and likely not do AS if they are at best borderline AS.

Interestingly I had one guy here at HW have one small portion of a single core come out as G6 and without a 2nd opinion he went and had surgery. And when the prostate was reviewed ~ the pathologist found no cancer. If I was that guy, I would have wished to have had the 2nd opinion find that tidbit of information rather than the surgeons knife. As it turned out for this gentleman he had extensive family history with prostate cancer and issues with BPH ~ so he wasn't sad to see the gland go away...

Tony
Posted 2/1/2011 9:01 PM (GMT 0)
I firmly believe that through careful manipulation over decades, the Medical Establishment has arranged The System so as to extract AS MUCH MONEY AS POSSIBLE from those seeking medical services...The whole system is set up so as many people as possible make as much money as possible...

As for getting a second opinion on a prostate biopsy, when you are in that "one core showed 10% Gleason 6" situation, then yes, by all means get that expert second opinion..But if your pathology report comes back "2 cores with 30% Gleason 6 and one core with 20% Gleason 7, I think you can save your money..
Posted 2/2/2011 4:37 PM (GMT 0)
I had my biopsy done in Thailand for a 24 core if I remember correctly it was about 700 US I had open surgery done in the best hospital in Thailand and it cost 14000 US for a 5hr operation which lncluded having an blood doctor on standby (I have a problem that I bleed alot) as for the worry about a third world operation I was left with no problems of incontinence and I have had no problems with ED from the day I left the hospltal
Posted 2/2/2011 6:12 PM (GMT 0)
Colin,

Did you have your treatment at Bumrungrad? A good friend is the CEO.
Posted 2/3/2011 2:11 AM (GMT 0)
JNF

I had the operation in the Bumriungrad but I had the biopsy in Pattaya
Posted 2/3/2011 2:41 AM (GMT 0)
Five years ago, my 12-core biopsy done in the urologist's office was $1100 and included pathology review.  It was covered by my insurance, except for a small deductible I paid.
Posted 2/6/2011 7:26 AM (GMT 0)
Ours is a good example of where the second expert opinion went from a diagnosis of ASAP (which basically means that cancer is suspected but cannot be diagnosed) to 3+3.

I believe that decisions should be made on the best data available and the $400 we spent on the expert biopsy review was worth every cent.

Reading those slides is not a black and white deal - it is a bit if a dark art. There are only a handful of people in the world who look at prostate slides day in and day out. They are used to seeing benign cells that look like cancer and vice versa. The sheer number of diseases an average pathologist sees and the variety in the pathology of prostate cancer makes a slide review a very sensible option. We researched our first pathologist - the only paper he had ever written was on liver viruses.

That is why the experts in the field, Walsh, Strum are two easy examples to check on, recommend a biopsy review by an expert.

An
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