Posted 8/18/2016 4:54 PM (GMT 0)
I think the $$ difference is several thousand $$ - they bring in a radiologist to read the mpMRI (because it's a diagnostic tool) whereas they just fuse the image with a CT for planning when they do a T1. I always ask doctors "how much will this cost? when I go into a meeting with them- they universally look at me like I'm crazy for even asking. My co-pays for a procedure I had done was $2000 (the insurance co. paid about $6000) - and it was just to get a botox injection in my arm. I complained to billing and they eventually dropped the charge, accepting only what the insurance company paid. Another hospital charged me $2200 after insurance for the unreimbursed cost of putting a few stitches in my forehead. I demanded a detailed breakdown of actual costs, and they eventually reduced it to $10. But most people pay these outlandish charges. How many people ever challenge the billing departments? I can understand why insurance companies drop out of the insurance exchanges. But then they challenge coverage for so many necessary drugs and procedures. It's a mess!
For prostate cancer, there are unnecessary procedures like bone scans on low risk patients, mpMRIs before a first biopsy, 40-44 IMRT treatments when 20 accomplish the same effect, multiple radiation treatments for bone mets, proton therapy that is no better than IMRT, and brachytherapy (the lowest cost primary therapy) is on the decline. Then there are unacceptable billing practices, like a shot of Lupron in a stand-alone doctor's office costs about $1000 less than if given when one sees the same doctor in a hospital. As patients, we can do something about these things, but how many of us know about them? And how many of us would say to our doctor "don't give me the Lupron -- it's cheaper if I have my GP do it."
And why is it that you had to pay substantial out-of-pocket fees to get your PSMA-PET scan at UCSF, while patients getting a PSMA-PET at NIH in Washington DC pay nothing? If we can nationally subsidize one clinical trial, why can't we completely subsidize trials throughout the country? And then, if we do, shouldn't that reduce the costs when they are FDA approved? Why does ACA only cover drugs on clinical trials but not clinical trials for diagnostic procedures and treatment procedures?
Yes, I agree that one way to solve the problem is to nationalize all insurance (like the VA or Medicare), to set maximum fees, and to change the way doctors and hospitals are compensated (by meeting patient goals rather than billing for each service). Then, anyone who wants extra beyond the covered drugs and services can buy extra insurance. I think that's the way it's done in Australia and France. But I don't see that happening in the US.