Shocked by "sticker price" of biopsy

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capamando
New Member


Date Joined Oct 2010
Total Posts : 15
   Posted 11/9/2010 12:40 PM (GMT -7)   
Hello again,

I had made an appointment to a a TRUS biopsy done when I received a call from the office manager apologizing for only giving me the cost of the doctor fee.... she then mentioned that the lab work for the twelve tissues was an additional $2500 bringing the total to over $3200...:shock: The good news according to her was that since I was paying with out of pocket money the cost was reduced by thousands of $$$$. I guess I was one of the lucky ones! (sarcasm). On previous posts I mentioned that my PSA went up from 0.6 to 0.9 in a period of six years but the last DRE I had, the urologist felt a nodule...thus my desire to get a biopsy or wait 3-6 months and get checked again. Given the $$$ situation I have opted to wait the 3-6months and get a new PSA and DRE. I have also considered going abroad to have this procedure done.. Does anyone know of a country where I can have this procedure done? If Iam going to pay $3000+ in the US, I rather get it done outside of the US and take my wife on a short vacation. :grin:

Your advice and comments are appreciated

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 24403
   Posted 11/9/2010 12:42 PM (GMT -7)   
My 3 biopsies averaged about 1,500 USD each, including the uro fee and the lab, and with our insurance, never even paid a cent out of pocket
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

Swimom
Veteran Member


Date Joined Apr 2006
Total Posts : 1731
   Posted 11/9/2010 12:47 PM (GMT -7)   
Perhaps I missed something but did you say a mere .3 rise in six years prompted a biopsy? I guess I have to wonder what your family history is, was the PSA before or after a DRE, what age reference is being used and does the Uro have kids in college?
No way does it seem appropriate to leap into jabbing a guy 12 times with a 20g needle over a PSA of < 1.0...especially if it happened over a 6 yeart period.

capamando
New Member


Date Joined Oct 2010
Total Posts : 15
   Posted 11/9/2010 2:12 PM (GMT -7)   
Hello,

Purgatory, sounds like my urologist is overcharging me or else his procedure and lab work is done by Nobel Prize winners... lol. I will check with another urologist to compare.

Swimom,

Yes my PSA only rose .3 in six years(done before the DRE) but don't forget that they noticed a nodule in my prostate. My father is 77 and he had issues with his prostate but it was not cancerous. The fact that there is a nodule (confirmed by two uros) is what concerns me.

I was also wondering if I could go outside of the US for the biopsy(save$$) and if PC is detected then continue treatment in the US. However, if I can find an uro that can do the whole procedure for around $1500 then I will choose to do it locally or maybe wait 3-6 months and get another PSA/DRE


Thank you both for your help

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 11/9/2010 2:20 PM (GMT -7)   
Hi Capamando,

Sorry I don't have any inputs on out-of-country (US) biopsy procedures, but I would say that treatment choices are completely independent of diagnosis procedures. It is very common that one urologist perform biopsy, and a different doctor performs treatment (urologist if surgery, but not a urologist if radiation treatment). 
 
"Reading" the biopsy is an important task best left to expert pathologists (one who specializes in prostate biopsy samples, such as Dr Bostwick at Bostwick Labs or Dr Epstein at Johns Hopkins).  They can provide 2nd opinion readings.

I'll check my records tonight and see what my biopsy charges, for your reference.

I also wanted to comment, and I see that you also just completed a response to swimom, that a DRE nodule is a strong indicator that a biopsy is appropriate, irrespective of PSA.

best wishes...

Post Edited (Casey59) : 11/9/2010 1:23:46 PM (GMT-7)


142
Forum Moderator


Date Joined Jan 2010
Total Posts : 5969
   Posted 11/9/2010 2:40 PM (GMT -7)   
My biopsy billed out, including the doctor, visit, and lab work, at $6,900 USD for 12 cores. It was done in the US.
 
More than half of it was the lab costs, a part of which were written off, as the insurance refused to pay for more than 6 cores.
 
As to PSA, I still think back at the quote from Walsh's book, which I'll paraphase - you can have a very low PSA, and have cancer, and you can have a very high PSA, but not have cancer. PSA is just one indicator.

MrGimpy
Veteran Member


Date Joined Jul 2009
Total Posts : 504
   Posted 11/9/2010 2:55 PM (GMT -7)   
and the price of Gold does not shock you !!!

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 7756
   Posted 11/9/2010 3:04 PM (GMT -7)   
Here is an interesting look at the costs for prostate cancer biopsy.

healthcarebluebook.com/page_Results.aspx?id=92&dataset=MD

This was fairly consistent (1,500.00) with the costs my insurance paid. I have done a costs analysis of active surveillance where I outlined the costs to be about 3k. This would include a second opinion on the slides.

When I was with David Bostwick, i learned that Bostwick Laboratories LLC has a program for uninsured men you might want to look into. Bostwick will only charge what Medicare will pay for patients without insurance. this substantially reduces what you would expect to pay...here is that link...

/www.bostwicklaboratories.com/global/patients/patient-billing/billing-policy.aspx

The thing you will need to do then is get the biopsy samples. I understand that CDU biopsy is only a few hundred dollars according to some members here, however I also learned that some high cost PCa doctors like Duke Bahn has stopped accepting Medicare since they won't pay what he can get for his services.

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

capamando
New Member


Date Joined Oct 2010
Total Posts : 15
   Posted 11/9/2010 3:14 PM (GMT -7)   
Hello,

Veteran, thank you for sharing that info. Whew! In my case my insurance only kicks in after I fulfill the $5000/year deductible...then it pays 80/20 until I reach the $10,000 ....100% after that up to one million. Of course, their criteria for payment is quite strict. I am going to seriously look into having this biopsy done outside of the US.

capamando
New Member


Date Joined Oct 2010
Total Posts : 15
   Posted 11/9/2010 3:17 PM (GMT -7)   
Thank you TC-Las Vegas for such good info

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 5969
   Posted 11/9/2010 3:25 PM (GMT -7)   
Capamondo,
 
You might have seen in other posts that I suffer from an ultra-high deductible / out-of-pocket as well. And it is going up for 2011. The only way I got out of all this with rent money left was to spend a lot of time researching in-network doctors, and demanding in-network services. I look back and think that if I had had that time to help understand what was going on medically, instead of trying to deal with bills, I might have been better off, at least mentally. I did (and still do) have good doctors, no complaint there, but to be constantly on edge wondering what the next day's mail will bring is not the best way to head off to surgery.

tatt2man
Veteran Member


Date Joined Jan 2010
Total Posts : 2820
   Posted 11/9/2010 3:49 PM (GMT -7)   
regarding medical costing - .... is there a thread here on HW dealing with what is covered by your Veteren's Administration for those who served in Viet Nam and the tie into exposure to Agent Orange and resulting health coverage by VA....

-that link might help those reading this thread who are needing financial assistance and qualify...

(post editing- there may be more links - here is one)
www.healingwell.com/community/default.aspx?f=35&m=1739180

foreigner hugs,
BRONSON

Post Edited (tatt2man) : 11/9/2010 2:52:36 PM (GMT-7)


Ger42
Regular Member


Date Joined Apr 2010
Total Posts : 189
   Posted 11/9/2010 4:19 PM (GMT -7)   
Bostwick lab $2,280.00 insurance paid $357 I paid $1,058. Urologist $915 insurance paid $582 I paid $146
12 samples taken
Age 68 weight 185 height 6'
Samples taken 4/19/2010 sent to Bostwick
3 out of 12 samples cancer
1) gleason score 3+3 involving 65%
2) gleason score 3+3 involving 65%
3) gleason score 3+3 involving 10%
PSA 3.5 Mar 19
PSA 2.5 Apr 4
Bone scan clean CT scan clean
Da Vinci 10/12/2010 DR Paul Kahn all nerves spared
Home 10/19/20
Cath out 10/22/2010
Prostate 56 gm. Gleason grade 3+4 = 7

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 7756
   Posted 11/9/2010 4:22 PM (GMT -7)   
Ger42,
Do you know what Medicare might have paid?

Tony

ruggles
Regular Member


Date Joined Jan 2010
Total Posts : 26
   Posted 11/9/2010 5:33 PM (GMT -7)   
Cap, my 12 core biopsy done at a doctor's office was billed at $880 ($645) plus $150 ($130) several days later to deliver the bad news, plus $2280 ($840) for the Pathology at Bostwick in PHX.
 
The insurance negotiated rates that they or I payed (deductable not met) are in parentheses. I can speak VERY highly for the Bostwick report, and since you are making major decisions based on those few sheets of paper, why settle for questionable reporting. My surgery pathology was not confidence building. They didn't even report the weight of the gland.
 
Recently I sort of reached the end of the streaming bills and loaded them in a spreadsheet to total close to $70k. The final payouts by me or insurance was a quarter of that! Keep asking your doctor or pathology lab for the cash price and you may find some reprieve.
 
Also on the USTOO webinar last week for Understanding Diagnostic testing the presenter referred to positive DRE's leading to PCa half the time, which was a suprisingly low number to hear.
 
Remember that getting the biopsy may be a dry run for vetting the Urologist and/or a Surgeon, so while you might save a little money with a foreign vacation, you start from scratch if the biopsy is positive.

Age 59 PSA: 8/09 - 5.7, 10/09 - 6.4, 12/09- 7.2, 2/10 - 7.4
12/09 FreePSA 10%
Biopsy 12/09 3/12 cores positive for 3+3 (10%, 20%, 20%)
Multi-focal Adenocarcinoma, 4th core Hi PIN
DREs negative
daVinci 2/9/10
Path: still 3+3 clean margins, appears contained to 5% of prostate
Dry at 5 weeks, total ED corrected with TRIMIX

capamando
New Member


Date Joined Oct 2010
Total Posts : 15
   Posted 11/9/2010 6:14 PM (GMT -7)   
Hello,

Thanks to all of your helpful information. It is really comforting to be a member of this community even if we had a choice, would rather not be here...LOL.

I followed up with the information given by TC- Las Vegas and I called the Bostwick Lab people. First I spoke with their customer service rep and she found urologist in my area that work with Bostwick. She then transferred me to their billing Dept. and I spoke with a very nice lady who told me that self payer like myself pay $100/vile x 12 cores= $1200. This amount is an estimation based on one basic procedure. She said that if the doctor orders more extensive test(she mentioned something about more complex ink test ???) the cost would go up significantly. She also send me a package that based on your financial need, Bostwick would lower their fees around 50% . They also have payment plans and a 20% discount if you pay the lump amount. Oh, one more thing she mentioned is that sometimes the doctor can work out a lower fee with the sales rep from Bostwick.

Please if this information interests you go to the reply by TC-Las Vegas for the link.


Thanks again and best to all

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2632
   Posted 11/9/2010 6:24 PM (GMT -7)   
I can only speak for myself on this issue. My health is worth whatever I have to pay ( not meaning I won't try to get the best price). Quality is a big issue as well. I suppose you might find some third world country who will do a biopsy for hundreds, maybe thousands less.

What will you do when you get an infection from unsanitary conditions, or poor technique ? What will you do if the cut-rate pathologist tells you you have a low grade PC, and then find out later it is not ?

I would say that I would go buy some good insurance ( new law on pre-existing conditions) and then cancel it after the biopsy. But be careful about too much bargain hunting for a very important diagnostic testing procedure in the PC world.

Goodlife
Goodlife
 
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01
1 year psa (364 days) .01
15 month PSA <.01

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 7756
   Posted 11/9/2010 6:39 PM (GMT -7)   
capamando,
The real bonus is the quality of workmanship you can expect from Bostwick. David Bostwick is regarded as one of the top pathologists in the country. And he is a very nice man. He has sent me those same packages for my UsTOO prostate cancer support group that I run in Las Vegas.

I am glad the link helped you.

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1821
   Posted 11/9/2010 8:21 PM (GMT -7)   
goodlife said...
I can only speak for myself on this issue. My health is worth whatever I have to pay ( not meaning I won't try to get the best price). Quality is a big issue as well. I suppose you might find some third world country who will do a biopsy for hundreds, maybe thousands less.

What will you do when you get an infection from unsanitary conditions, or poor technique ? What will you do if the cut-rate pathologist tells you you have a low grade PC, and then find out later it is not ?

I would say that I would go buy some good insurance ( new law on pre-existing conditions) and then cancel it after the biopsy. But be careful about too much bargain hunting for a very important diagnostic testing procedure in the PC world.

Goodlife


Yes you take your life in your hands using those third world countries outside the US, countries such as the UK, Germany, France, Sweden, Australia, New Zealand, Singapore, Japan etc. etc. I mean after all, they can only manage to deliver to their populace a significantly higher life span, and a very noticeable lower infant mortality rate than the US and manage to do this at a much lower cost. Meanwhile many of those countries deliver these results with (shock! horror!) universal health schemes shocked smilewinkgrin

capamando
New Member


Date Joined Oct 2010
Total Posts : 15
   Posted 11/9/2010 8:22 PM (GMT -7)   
Hello,

I think for the time being, I am going to see what Bostwick can do for me and talk to one of the urologist in my area that uses Bostwick for their lab work. Thank you very much to all of you for your support.

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 5969
   Posted 11/9/2010 8:38 PM (GMT -7)   
Billy,
 
I suspect that the "medical tourism" was more like Mexico, India - there are a number of places that have a less than perfect reputation. At least for myself, Oz and western Europe don't fall in that list.
 
You are supposed to be out in the wilds, no?
 
 

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2632
   Posted 11/9/2010 8:42 PM (GMT -7)   
Billy,

You obviously are being facetious. You failed to list a third world country. I obviously meant no slam on anyone.

We hear all the time of great medical deals in Mexico or South America, or the Caribbean Islands. We also hear of medical screwups qnd scams as well. If my choice was to fly to Germany, Japan, or Australia, I could probably just as well pay for the biopsy. Around these parts, most folks head south.
Goodlife
 
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01
1 year psa (364 days) .01
15 month PSA <.01

BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1821
   Posted 11/9/2010 8:59 PM (GMT -7)   
I was and am glad you picked up on it. Mind you if it were me and I could say, fly to Europe, have a short holiday (including the fun of a biopsy) for the same price that I could at home, then it's up, up and away. And we get the same stuff here ........ only it is in Asian countries (usually cosmetic surgery). I hear the West Europeans have the same set up going to eastern European countries (again usually cosmetic).
Bill

Post Edited (BillyMac) : 11/9/2010 8:03:26 PM (GMT-7)


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1821
   Posted 11/9/2010 9:05 PM (GMT -7)   
142 said...
Billy,


I suspect that the "medical tourism" was more like Mexico, India - there are a number of places that have a less than perfect reputation. At least for myself, Oz and western Europe don't fall in that list.



You are supposed to be out in the wilds, no?


Put the departure day back one day to fix a couple of small problems with the RV. We're off in the morning now.
Bill

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 11/10/2010 8:11 AM (GMT -7)   
Casey59 said...
I'll check my records tonight and see what my biopsy charges, for your reference.

Capamando, I promised to look up my records and get back with you last night, but got busy celebrating a family birthday (mine), and so didn't look this up until this morning.
 
It looks like you have gone quite a ways down the path of knowledge with various good inputs already plus your own legwork, but nonetheless I though I would provide you with my promised response.
 
My complete biopsy procedure, which included my urologist pulling the samples in his office and then sending them off to Bostwick for reading, was billed to my insurance at $2,100.
 
good luck...
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