Insurance coverage for Color Doppler

Welcom to HealingWell. This proabably not an issue, but you really need to check with the provider to make sure they take your insurance, and also with your carrier to make sure you have the proper clearance.

I hope you add a signature and tell us about your case...

Tony

Welcome.
Sorry you have had to join our little group.

My experience is to have the doctor get literally everything pre-authorized by the insurance company, and check/re-check that all of the involved doctors are "in-network" before getting any procedures to avoid issues (I've had my share even after perfect paperwork.)

I've had experience with Aetna for surgery in the recent past, and am still in the civillian worker's world of insurance, not retired, not military, so no tricare, no medicare yet.

I'm not kidding. Get your uro or the prescribing doctor to pre-authorize everything and every name, even if they tell you it is not required, and if at all possible stay in network. Once they approve it, life is easier. They may decide something really isn't covered, but at least you have a scrap of paper to work with. It was the difference between $3k total exp. for the year vs. covering only 70% of "in-network agreed price" with a $9k deductible, then I would have to pay the 30%, and the delta if the provider did not accept the write-off.

Done in network, DaVinci cost me about $4k out of my pocket. Out of network, it would have been $12k minimum, probably closer to $15k out of my pocket.

I did get everything done that I asked for, but I hadn't found this site, didn't know about color doppler, so didn't ask for one. I did have some things refused as experimental, but the practice was in-network, and therefore obliged to write it off.

I know that the philosophy is that you should get the best care possible, but at $15k, I would have had to pass on treatment and hope to live to get to medicare, go bankrupt (and lose my job in the process) or win a lottery ticket. A brutal form of 'AS'.

Just ask the provider of the service to get "pre-authorization" from your insurance. No nasty surprises later on.

Does "Windquest" = "Volunteer"??

My friend (and I mean that) you are going through an awful lot of time and trouble to avoid a simple biopsy.. Chances are, you are going to get one anyway, the only difference being you are going to spend A LOT more money for yours...This is not the cosmic cross-roads you seem to think it is...

Post Edited (Fairwind) : 8/12/2010 4:48:25 PM (GMT-6)

Hi Fairwind....you are correct about windquest=volunteer, the name was taken on this forum.

I think you are quite mistaken, I am NOT trying to avoid a biopsy, I just don;t want ANY procedure just because that's what everyone gets. I have spoken to six other Doctors, and not all agree that the biopsy should be automatic....one suggested that as a whole, we are over biopsied causing additional problems. According to John Hopkins, there are 800,000 done each year. Dr. Bahn I think is on the right page...at least for me. He may, or may not take a biopsy...all depends on what he finds but more importantly, we will have an image to compare the next image with if we are still waiting. It is easier to determine changes and avoids another "shot in the dark biopsy".

Responding to my question on this thread, I have found that I might have a problem with my insurance although I don't think so BUT I found the cash price will be actually less than my insurance co pay and deductible. I could start a whole new thread on this, but I am appalled at what a rip off the medical system is here.(I have lived out of the country almost 10 years) One Doctor I talked to said that they billed out biopsies differently for each insurance company!

Anyway, this time I will pay cash, and go to California

I'm not! Color Doppler Ultrasound is FINE with me...It's probably a fine tool to avoid unnecessary biopsies..But we are dealing with a potentially terminal illness here so the term "unnecessary biopsy" is perhaps being misused..

If I had a PSA number three times normal and a sudden increase in velocity and infection had been ruled out, I would be BEGGING for a biopsy, not an ultra-sound exam, color doppler or otherwise...

PCa is a lot trickier than people think. That Gleason 9 core they pulled out of me during my third biopsy came from the same area that was CLEAN 14 months earlier...

I was living down in Mexico, knowing my U-doc wanted to do a third one..I was trying to avoid it anyway possible..So I went and had a PSA test done down there, hoping the number would be stable..When it came back 7.0 in May, (it was 5.6 in March) I lost all motivation to resist that third biopsy..