Feeling scammed by my doc

At my six month check-up, my surgeon/urologist agreed that I could switch my PSA testing to my primary care doc, with the agreement that I let him know if the PSA level ever became detectable.

I have a huge out-of-pocket cap on my insurance, and a fairly high up-front deductible. I pay the first $5K per year, and then I pay 20% of everything until I've hit $11,600 out of pocket for the year. I got stuck with the worst insurance of my life not long before I got my initial diagnosis and health care costs are killing me.

The bill for my last visit to the urologist, including the PSA test, was close to $500, while a 15 minute visit with my PCP plus the blood test is closer to $150. The out-of-pocket difference for me is significant.

So, I had my blood test done 2 weeks ago, and after 12 long days, I got the result this week. It read "< 0.09". Perfect, I thought. As a courtesy, I sent a scanned copy of the result to the urologist's office. Apparently, he looked at the report and didn't like it at all. His nurse told me he didn't like the lab where it was done, although I'm sure something was lost in translation there.

At 3 months, he had done the regular PSA on me, with a result of "< 0.10". At 6 months, he did the ultra-sensitive with a result of "< 0.03". Maybe he wants the ultra-sensitive result and didn't tell me that, and I deliberately did not ask my PCP for that test - for both cost and potential anxiety reasons.

Perhaps he misread the report. The formatting is a little bit funny, with some underscores, and it really looks like "<_______0.09". Maybe he missed the "less than" sign and thinks the PSA is now detectable. Or maybe it's something else.

But, his nurse called me and told me that he wants to see me within 2 weeks and I need to be re-tested by the lab where he works. This will be another of those $500 visits. He gets to code the visit with the prostate cancer diagnosis, which increases the complexity of the visit, and allows him to bill more money. My PCP isn't seeing me in the context of PCa, so he doesn't code it that way. I'm really unhappy about this, especially given that the visit notes for my last visit with the surgeon explicitly say that I'm going to be tested by my PCP going forward.

So, next Thursday, I get to miss an afternoon of work, I get to drive almost 100 miles round trip, and I'll get to pay about $100 out of pocket for an unnecessary (in my opinion) re-test.

I keep wondering what would happen if I refused to do it.

Post Edited (dmlvt) : 10/24/2014 1:31:55 PM (GMT-6)

dmlvt, this seems quite clearly to be something which warrants a telephone call to clear up any and all misunderstanding between what you THOUGHT was going to happen and what seems like IS happening.

Just sayin', if it was me, I wouldn't take off work, drive 100-miles, etc. without clearing this up FIRST. 

And by the way, there's no need to rush in anyhow.  Cancel the appointment if you don't get through to him on time with the knowledge that it could me rescheduled depending on the eventual outcome of the call you will have with your doctor...but with your post-surgical pathological results, you've got incredibly little to worry about now.

As the old Yellow Pages ad jingle used to say, "Let your fingers do the walking..."

You are all, of course, absolutely correct. I just sent the following note to the surgeon's office, through the online portal:

"Before I take half a day off work next week, drive almost 100 miles round trip, and pay the deductibles on another lab test and visit, I think I'd really like more clarification on the result from xxxxxx's lab. I can only think of two reasons why Dr. xxxx might be concerned with the result. The first is the formatting of the result on the report, where there are a number of underscores. To me, the result looks like this: "<______0.09". Is it possible that Dr. xxxx did not see the "<" symbol, which might otherwise indicate some detectable level of PSA?

Or, is it possible that he wanted the ultra-sensitive test done and I had the regular assay performed? At 3 months post-op, I had the regular assay, which returned a value of "< 0.10". At 6 months, the ultra-sensitive test was done, which returned a value of "< 0.03".

In my visit notes from 7/14 of this year, Dr. xxxx specifically said that we discussed that I would be tested by my PCP and I would report any results that showed the PSA as "detectable".

The result from xxxxxx does not show a detectable PSA.

I really think I would like a more detailed explanation about why the result from xxxxxx is an issue. In terms of time away from work and my travel and my deductibles, this is an appointment that will cost me hundreds of dollars.

Thank you."

The urologist/surgeon does know that I re-started TRT. The endocrinologist would not let me re-start without visit notes from my surgeon saying that he thought it was reasonable to do so. I think I'm the first person my endo has allowed to re-start at 6-months post-op rather than a full year or more, and it was because of my favorable pathology and with the permission of the urologist. My tumor volume was fairly small, and only 5% of that volume was Gleason pattern 4, and that focus of GP4 was nowhere close to the margins.

He told me at my last visit that "There might still be some cancer in there. There might not. But, the testosterone will make no difference either way".

If the hospital responds and tells me that they want the ultra-sensitive test because of the TRT, I'll have to ask why they didn't tell me that months ago. And then, I'll have it done closer to home.

Suggestion: start getting control over your whole medical thingy, you can maybe get a psa test from a free screenings type facility (they exist) and even some hospital or clinics might offer a walk in psa test cheap-cheap. Here in Michigan Crittenton Hospital in Rochester, Michigan offers walkin psa testing for
$15 and mails the results to you and your designated doc you mention and you can get results either by waiting a few hours or online via a portal weblink they offer. Paying huge bucks for a psa test is a rip off and then adding an office visit makes it worse for you.

You decide whom your docs are or hopefully you have that type of option, learn a lot and realize the whole thing is of questions on and on. Have you read up info at www.yananow.org ?? lots of good info on PCa and around 1000 patient histories to read up on or contact some of them too.....

I have been fighting this _____ for over 12 years now and started with lousy prognosis and high stats. I did have the power to hire and fire some docs and found out it can be a wise decision. I have learned to question everything and all the time, and found it serves PCa people very well as changes in this stuff happens as to defining it, handling it, protocols and more. Realize the limitations of things like scans and that opinions vary from doc to doc, even....this is the kind of reality you will see. You may see that money is a huge driving force for all cancers, alternative options and less than mainstream things are considered junk but are they???? Beware also of snake oil type sales or claims, a lot of people cashing in on this. Nobody walks the walk as the patient does, so remember it is yours to deal with and you have choices. Best to you.

As stated, this is something you can decide. I switched to free tests through an employee contracted clinic, for PSA and T tests and for getting the T injections. Insurance plays games by denying prescription coverage coverage for injectable T, as opposed to covering it as an injection in the uro's office visit. Still, since the deductible is my money and I save several hundred per year overall, I moved. The uro still sees me for follow up on an annual basis and gets to run his battery of tests at the PCa treatment billing rate.

For peace of mind that results from the different labs could be compared, I did get one pair of duplicate tests from the clinic and the uro's in house lab. They were drawn within an hour of each other. Results were quite close across both full panel tests and were well within normal ranges.

I am grateful for quality care at both the clinic and the uro, and that treatment got me to where I have this type of issue as my most critical choice. Both have arrangements that allow them to make a fine living, so I'll shop for value to optimize my own situation.

Explorer

Not sure but I think my hospital pulled a little scam on me recently. I have reached the max on my out of pocket on insurance so I don't have to pay anything the rest of the year with insurance picking up the entire tab. At least that is what I thought. I got my most recent PSA at my hospital's lab. Well, the hospital rep tells me I have two choices. If the hospital handles the insurance I will have to pay them $90 but if I bill through Labcorp there is no cost to me. Only problem I have to have my results in five days and she says I will have them same day if I file through the hospital but it could take a week or more with Labcorp with no guarantee the results will be provided to my Uro within that timeframe. So guess which route I took since I had a doctor's appointment in less than a week. Odd thing is, regardless of which route I took the testing would be done in the hospital by a hospital employee. And the hospital would handle the paperwork too. I am still trying to figure that one out. Also when I got my insurance EOB, there was nothing on it showing where I owed the hospital $90 ( I had to pay them in advance). And to add to the mystery in all my years of getting my PSA at the hospital, I was never given that option before.

I got a note from the doc. He missed the "less than" sign in a poorly formatted report. We agreed to cancel the new appointment and I will be re-tested locally in 3 months.

Thanks for all of the comments.


Damon

Missing the < sign is the most common mistake made in all of psa testing. You wouldn't expect it from a doctor. But then i never expected it from a nurse, lab tech etc. But there it is.