Salvage IMRT Costs

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pasayten
Regular Member


Date Joined Mar 2007
Total Posts : 385
   Posted 3/14/2010 9:46 PM (GMT -6)   
Hello All....
 
 
I Just finished my 32 treatments of salvage IMRT and thought I would pass along the bills/costs just for information.   I spent my first day back home (I stayed with friends for the treatments due to location) doing all the bookwork...
 
Included are all the initial visit and setup stuff including bone scans... MRI...   cat scan...   and then followed by 32 treatments of 2 gys each for a total of 64 gys.
 
Seattle Viginia Mason Hospital and Oncologist...
 
List price   $65,500
 
Negotiated price thru Blue Cross/Blue Shield   $38,100
 
Each daily individual treatment listed around $1541 with a $834 negotiated price
additional Xrays and doc consult once each week
 
My out of pocket...   reached $5,000  yearly catastophic limit during week 6 of the treatments.
 
I am amazed at the difference between the "list" price and the "negotiated" price...   If I did not have insurance,  I would have had to pay the $65K list price....    That is SO WRONG...    Everybody should get the same "negotiated" price or near that!
 
God Bless All,
 
pasayten
 


After 3-4 years of annual PSA 4-6, biopsy recommended
3/13/2007 - 12 point biopsy - Left 0/6  Right 1/6 Gleason 3+3 T1c
4/24/2007 - DaVinci performed at Virginia Mason hospital in Seattle
5/2/2007 - Catheter Out! Final pathology of Gleason 6  T2c Nx Mx, approx 20% of prostate involved, positive margin, but only at 2 focal points.  
6/28/2007 9 weeks incontinance... Overnite, went from 4-6 soaked pads a day from prev 8 weeks to 2 barely wet pads a day.
7/12/2007 11 weeks post-op  Minimal leakage...  one small pad a day
7/18/2007 First Post-Op PSA...  0.01 !!! 
9/10/2007 Pad free and ED at 75% with 100mg Viagra generic
6/26/2008 2nd Post-OP PSA at 14 months...  0.02 
12/2/2008 3rd Post-OP PSA at 20 months...   0.03
10/30/2009 4th Post-OP PSA at 31 months...   0.13 (moved and diff lab)
11/3/2009 Retest at my original lab...  0.11  (followup with Doc sched 11/10)
11/10/2009 Discussion indicated biochemical reccurrence and need for salvage radiation treatment. 
1/21/2010 Another PSA test at 34 months...  0.14
1/26/2010 IMRT Salvage Radiation Treatment started
                  32 sessions for 64 gys total.
3/3/2010 25 down and 7 to go...  No side effects to date except a little
tiredness.  Sometimes feel like a slight sunburn on the inside for a few hours after treatment.
 

Post Edited (pasayten) : 3/14/2010 9:52:43 PM (GMT-6)


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1766
   Posted 3/15/2010 6:09 AM (GMT -6)   
The "negotiated" price with insurance companies is based on several factors. The larger the medical practice, the more bargaining power - hence, not many doctors remain in a solo practice. My OB/GYN is thinking about joining a large practice in our area. He has always been against this but recognizes that he can negotiate far better reimbursement rates with the insurance companies if he has the power of numbers behind him.

BTW: $1,541 per treatment is not a bad price for rad treatments. My friend's husband had palliative radiation for tumors along his spine and the "list" price for each treatment was close to $3,000.
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (solitary focus of extraprostatic extension). Perineural tumor infiltration present. Apex margin, bladder neck and SVs negative. Final Gleason 3+4. PSA: 0.0 til July 2009. August 2009- 0.1, September 0.3, October back to 0.0, December 0.0. Thank you God!


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2040
   Posted 3/15/2010 6:53 AM (GMT -6)   
I was getting caught up on my medical bills this morning and here are my figures for IMRT.

Billed to Insurance for each treatment -$3406.00, Paid by Insurance Plan -$1103.54, my responsibility -$122.62 for each treatment.

Sonny
60 years old when diagnosed
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
Gleason Score (3+4) 7 in all positive cores
da Vinci 9/17/09
Post Surgery Pathology: GS 4+3=7
Stage: T3a
Tumor Volume 12.5%
positive margin, extra-prostatic extension
30 day PSA 0.4, 50 day psa 0.53, 64 day psa 0.6
IMRT completed 1/15/10 35 treatments- 70Gy


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 23587
   Posted 3/15/2010 7:11 AM (GMT -6)   
The list on each of my 39 treatments were just shy of 4,000 @, so that would have been close to 156,000. I don't know what the settled price was with my wife's insurance company, because 3 1/2 months later, never been billed anything by wife's insurance company or the clinic.

Perhaps its like many things over time, or newer technology, but when I had non-IMRT radiaton back in year 2000, the totay 35/36 treatments at that time cost over 225,000.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, Caths #13 & #14 same time, 3/6 Cath #13 out - 4 days


JB71
Regular Member


Date Joined Nov 2009
Total Posts : 200
   Posted 3/15/2010 7:26 AM (GMT -6)   
WOW, those costs are just NUTS. I know some of you will be jealous when I tel you this but living in Canada does have an advantage when it comes to medical 'COST' issues. (never mind the political crap, for now)

So far my costs for several PSA's, DRE's, a biopsy,bone scan/Ct scan, consultations, open surgery, hospital stay, followed up homecare: drum roll:

ZERO, as in ZIP, NAtta !

Even my 'wait' times have been reasoable and I can start adjuvant radiation anytime I think my body is ready. Of course, mind wise, I'll never be.

Even with everything being 'free?', this decease sucks big time.
.
Age, only 71.
 
July 2009, PSA 9.1, free ratio 0.16
September GLEASON 4+4=8, T2A
Prostate 44cc.
 
Calcium: 2.46  (range: 2.20 - 2.65 mmol/L)
25 Hydroxy Vitamin D: 102 (range: sufficiency:
76 - 250 nmol/L)
 
Bone Scan: Negative
CT Scan scheduled for Dec. 1st. Negative.
 
Started Casodex 50mg. on Nov. 6, first pill of 30.
Got Lupron 22.5mg ( 90 day ) on  November 19.
 
No real side effects as of Dec. 15 except dry skin and hair but getting quite 'porky' in the belt area even though now I go to the gym, three times a week. Also I dont have a need to shave anymore so now I can save my 'shaving' allowance and direct it to my stash of Depends !
 
Christmas Day got my first hot flashes. Thanks Santa!
 
Open surgery scheduled for Jan. 22 by Dr. J. Chen
 
Open surgery done on Jan. 20th. by Dr. J. Chin at London's University Hospital.
 
Cath removel scheduled for Feb. 8th. Yes, I know,
that will be 19 days. Dr. is out of country until then.
====================================
Pathology Report:
 
Gleason Score: cannot be determined due to hormone therapy effects. ???????
 
Extraprostatic Extension:
present, left radial, multifocal
present, left basal, multifocal
 
Resection Margins:
Apical: involved by invasive carcinoma, multifocal
Bladder Neck: involved by invasive carcinoma, unifocal on left side.Other: non-tumoural prostatic present at resection margin.
 
Perineural Invasion: present.
Seminal Vesicle Invasion: absent
Lymphovascular Invasion: absent
Lymph Node Status: no malignancy in regional lymph nodes
 
Additional path. findings:
high grade prostatic intraepithelial neoplasia
 
Pathology Stage: yp T3a NO MX
==================================
Radialogist appointment was on Friday Feb. 26 with Dr. Glenn Bauman in London.
 
Got another Lupron 90 day shot today and he wants to start IMRT soon. CT Scan plus measure scheduled in about 3 weeks. ( march 20)
 
First PSA test since surgery on March 25th.
 
Next appointment with the surgery Doc is April 13.
 
.


60Michael
Veteran Member


Date Joined Jan 2009
Total Posts : 1736
   Posted 3/15/2010 7:38 AM (GMT -6)   
JB ,
You really cant beat that. I think my out of pocket per year is $2,000.00, so not too bad, But yes Pasayten I was shocked to see the cost but also saw the negotiated price. I just have to watch the insurance company closely as they "forget" what my out of pocket per year should be, so I help remind them with rude phone calls.
Michael
Dx with PCA 12/08 2 out of 12 cores positive 4.5 psa
59 yo when diagnosed
Robotic surgery 5/09 Atlanta, Ga
Catheter out after 10 days
Gleason upgraded to 3+5, volume less than 10%
Margin slightly involved
2 pads per day, 1 depends but getting better,
8/5 1 depend at night only, now none
 started ED tx 7/17, slow go
Post op dx of neuropathy
3 months psa.01, 6 month psa.4, 6 1/2 month psa.5
Starting IMRT on 1/18/10
Great family and friends
Michael


Galileo
Veteran Member


Date Joined Nov 2008
Total Posts : 578
   Posted 3/15/2010 10:27 AM (GMT -6)   
For my SRT, I had to pay $2,000, since that was my out-of-pocket limit. But I had just paid the same amount for surgery the year before, so this did torture my credit card.

It seems backwards to me, but this $2K cost was because we had the PPO plan through Blue Cross/Blue Shield. We have since switched to the HMO, which costs us a little more per month, but the next time one of us has a major procedure, there will be no out-of-pocket.

I think BC/BS paid about $35,000 for my salvage IMRT in total.

One of my kids (now okay) needed in-patient mental health care a few years ago. Now THAT was something. Without mental health parity in our state, we had to get a home equity loan to pay the $20,000. The $20,000 was only part of the cost. Insurance paid some, and the collection agency the hospital turned us over to (the days of making "good faith" payments are apparently over) reduced the total amount substantially in return for us paying it all off, lump-sum. We are now underwater in our mortgage.
Galileo

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NX MX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 and thereafter <0.1
http://pcabefore50.blogspot.com


deer hunter
Regular Member


Date Joined Jan 2010
Total Posts : 231
   Posted 3/15/2010 6:29 PM (GMT -6)   
H i g uys my SRT cost Atena $149,360. not counting med. lupron shot was $2300 each had 2 i had already meet my deductable of $4000. on bone scans MRI and CT scans casdex was 1400. for 30 day supply cost me $163. for 1month supply. It;s all crazy!!!!!!!!!!!!!!!
DEERHUNTER
dx age 57 01/06 open RP 4/06 psa in 01/06 8.1  surgery path report Gleason 3+4=7 poorly differentiated  tumor was 90%involved in both lobes surgical margins postive. in the right apex and right radial margins tumor grade G3  perineural invasion present high grade of PIN found  T2c NX MX PSA 0706  .01 10/06 .02 01/07 .03 04/07 .04  06/07 .05  07/07 .08 07/07 bone scans pelvic ct neg. 08/07 proscintic scan neg.9/07 psa.10 net with rad onc. wanted to do SRT but i did not do it 10/07  saw a new dr at Emory University [my old dr urg. suggested second opinion ]  bone scans negs ct scans pelvics neg. biopies of the bladder and adrinal glands neg.another proscintic scan neg.12/07 Psa .11 clinial trial Emory injected with protons to try and find the cancer cells no luck 3/08 psa .17 06/08 psa .23 psa 09/08 psa .32 12/08 psa .39 3/09 psa .39 6/09 psa .43  meet with medical onc. he said  i might have waited to long to start SRT 7/09 psa .50  another bone scan ct scan all neg.MRI neg. meet rad. onc. 7/09 started casdex 50mg 1 day for 30 days 2 shots of lupron started rad treament 10/09 40 treatments 75 gm 12 shots each time all aroud pelvic finished 12/09  psa .07 and psa 01/10.05 next dr visit 03/10 wait and see!!!!!!


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 3/15/2010 6:38 PM (GMT -6)   
I often wonder why hospitals bill ridiculously high amounts, only to settle for much less. My wife spent a night in the hospital couple of years ago. They billed us $18,000. The insurance paid them $1,800 and we did not pay anything.

I worked for a medical insurance (on technology side) but still clueless how this all makes sense. The Canadian system makes even less sense (no offence to our Canadian brothers) - your consumption of services has no relation to the cost to you (and no, nothing is free in this world - you are paying for it through taxes, whether you use it or not).
Father died from poorly differentiated PCa @ 78 - normal PSA and DRE
5 biopsies over 4 years negative while PSA going from 3.8 to 28
Dx Nov 2007, age 46, PSA 29, Gleason 4+4=8
Decided to participate in clinical trial at Duke - 6 rounds of chemo (Taxotere + Avastin)
PSA prior to treatment 1/8/2008 is 33.90, bounced on 1/31/2008 to 38.20, and down at the end of the treatment (4/24/2008) to 20.60
RRP at Duke (Dr. Moul) on 6/16/2008, Gleason downgraded 4+3=7, T3a N0MX, focal extraprostatic extension, two small positive margins
PSA undetectable for 8 months, then 2/6/2009 0.10, 4/26/2009 0.17, 5/22/2009 0.20, 6/11/2009 0.27
ADT (ongoing, duration TBD): Lupron started 6/22/2009
Salvage IMRT to prostate bed and pelvis - 72gy over 40 treatments finished 10/21/2009
PSA 6/25/2009 0.1, T=516, 7/23/2009 <0.05, T<10, 10/21/2009 <0.05, T<10


JB71
Regular Member


Date Joined Nov 2009
Total Posts : 200
   Posted 3/15/2010 9:01 PM (GMT -6)   
Geebra said... The Canadian system makes even less sense (no offence to our Canadian brothers) - your consumption of services has no relation to the cost to you (and no, nothing is free in this world - you are paying for it through taxes, whether you use it or not).
 
You are likely correct but since I'm poor and retired, I REALY DONT GIVE A CRAP.

Age, only 71.
 
July 2009, PSA 9.1, free ratio 0.16
September GLEASON 4+4=8, T2A
Prostate 44cc.
 
Calcium: 2.46  (range: 2.20 - 2.65 mmol/L)
25 Hydroxy Vitamin D: 102 (range: sufficiency:
76 - 250 nmol/L)
 
Bone Scan: Negative
CT Scan scheduled for Dec. 1st. Negative.
 
Started Casodex 50mg. on Nov. 6, first pill of 30.
Got Lupron 22.5mg ( 90 day ) on  November 19.
 
No real side effects as of Dec. 15 except dry skin and hair but getting quite 'porky' in the belt area even though now I go to the gym, three times a week. Also I dont have a need to shave anymore so now I can save my 'shaving' allowance and direct it to my stash of Depends !
 
Christmas Day got my first hot flashes. Thanks Santa!
 
Open surgery scheduled for Jan. 22 by Dr. J. Chen
 
Open surgery done on Jan. 20th. by Dr. J. Chin at London's University Hospital.
 
Cath removel scheduled for Feb. 8th. Yes, I know,
that will be 19 days. Dr. is out of country until then.
====================================
Pathology Report:
 
Gleason Score: cannot be determined due to hormone therapy effects. ???????
 
Extraprostatic Extension:
present, left radial, multifocal
present, left basal, multifocal
 
Resection Margins:
Apical: involved by invasive carcinoma, multifocal
Bladder Neck: involved by invasive carcinoma, unifocal on left side.Other: non-tumoural prostatic present at resection margin.
 
Perineural Invasion: present.
Seminal Vesicle Invasion: absent
Lymphovascular Invasion: absent
Lymph Node Status: no malignancy in regional lymph nodes
 
Additional path. findings:
high grade prostatic intraepithelial neoplasia
 
Pathology Stage: yp T3a NO MX
==================================
Radialogist appointment was on Friday Feb. 26 with Dr. Glenn Bauman in London.
 
Got another Lupron 90 day shot today and he wants to start IMRT soon. CT Scan plus measure scheduled in about 3 weeks. ( march 20)
 
First PSA test since surgery on March 25th.
 
Next appointment with the surgery Doc is April 13.
 
.

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