Posted 7/31/2017 7:09 PM (GMT 0)
I think there is a lot of confusing going on here and believe me (I gotta stop saying that phrase these days) its very easy to occur.
Yes, it's very hard to get any clear details prior to complicated or multi-party procedures. Insurance companies will tell you "we can't tell you the cost or the approved amount or your copay or co-insurance amounts till we get billed. REALLY! I mean is there ANYTHING in this world that works that way? Car dealer: "Yes, sir that blue (insert car here) is available, sign right here for your irrevocable obligation to purchase and pay for it, and we'll send you the pricing and bill and charges once you get home and drive it a few days - oh and NO returns for any reason ever!.. could you imagine?
Anyway, with the direct provider for doing the biopsy, one should be able to have a pretty clear upfront picture of what the facility and the dr. charges are going to be. Some are copays, some are co-insurance amounts, but they should be able to tell you based on an authorization to proceed and medically necessary approval.
2nd thing is, there really aren't any "labs". This isn't really a lab fee, it's pathology and that is very different. the initial pathology of a specimen or specimens is the most expensive as it involves more than just collection, it's also transport, preparation, dicing, storing, slicing, organizing, validation, putting on slides, transportation, reading the slides, confirming the read, a 2nd confirmation of the read, storage, etc. all that ads up and I can assure you it's NOT going to be 25$ for that "lab".
Some people here have quoted other place that will "do the pathology" for 250$, and many people have their slides sent to places like the brady institute at johns hopkins for a 2nd read. That's ALL that is, a 2nd read. It's nothing to do with all the things I listed on the pathology detail. If one has their complete biopsy done at Hopkins, for the PATHOLOGY it's going to be the bigger number for sure. Not including the actual biopsy costs.
Now, HMO's will often quote an all in fee, as they often do all the elements in house and have an all in price for that, but I don't think most here who are doing this sort of thing and commenting on it were on HMO's.
Just to give another number. When I had my biopsy, pathology and reads done at Stanford, they billed my blue cross about 30K all in for everything. 45 min in the biopsy room, pathology and diagnosis. Approved amount came to about 20K, and I have a 30% co-insurance amount for this sort of thing so my out of pocket was 6,000$ thats a LOT in my opinion. Fortunately, my annual out of pocket max is 7500$, and I already had about 2K in charges but still it was a 5,500$ bill. They did have a 48 month no interest payment plan available, which I took advantage of - DUH!.
But still, medical costs and this whole system is totally whacked.