Interesting Bit On Health Care Costs

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Date Joined May 2003
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   Posted 3/26/2010 1:27 PM (GMT -7)   
An abdominal scan for the Crohn's in 2003 indicated a 4 cm post-menapausal simple cyst on one ovary. I opted to just monitor this cyst and was told we could do so up to 8 cms as long as no symptoms and no problems. We've been doing twice a year ultrasounds since watching it slowly grow to almost 8 cms but now am being told if I want I can wait until 10 cms as long as no symptoms and no problems, but at 10 cms the chances of artifacts messing up the films is too great.
So all these years, "because insurance required it" we've been doing first an abdominal ultrasound (full bladder) and then the transvaginal ultrasound (ahhh, get rid of all that urine finally). These were all done at our local hospital.
My ob/gyn recently installed the latest ultrasound equipment and hired an excellent, experienced US tech. I opted to have the next US at his office. The tech did both the abdominal and then the transvaginal as usuall - AND THEN she told me that future USs will only need to be the transvaginal since they now have baseline abdominal US films. I asked her about insurance requiring both be done in order for them to be paid for. That's what the hospital always told me when I mumbled and grumbled about the amount of water needed to be drunk before the abdominal US.
So, obviously just one way the hospital managed to make a couple of extra bucks from the insurance companies. (Same insurance for me thru all this). Seven years of needless abdominal USs my insurances have been paying for!!!!
[*Edited to clarify it was 4 cms, not r cms, and a SIMPLE ovarian cyst - C2]

My computer says I need to upgrade my brain to be compatible with its new software.

Post Edited (CrohnieToo) : 3/28/2010 5:46:56 AM (GMT-6)

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Date Joined Apr 2005
Total Posts : 3763
   Posted 3/26/2010 1:42 PM (GMT -7)   
I have had an HMO through all but the first few months of my 22 years as a Crohnie. With all of the HMO's we never saw a bill, you just pay your co-pay and walk away. That was until January of this year when my husband's company was bought and the HMO choice was by far (double) the most expensive choice. We opted to go with the high deductible insurance and for the first time in my adult life I am getting medical bills and Explanation of Benefits. In less than 3 months I have found 4 mistakes, some for as much as $400 dollars. That's only 3 MONTHS. I don't even want to imagine what over charges there have been in the past 22 years. And they have been on both the doctors billing me and the insurance billing me. Not one of the mistakes has been in my favor! No wonder healthcare is in crisis.

CD 20 years officially, 30 unofficially. 3 resections '93, '95 '97
Managing with strict low residue diet, keeping symptoms to a minimum. All test show small amount of ulceration, still have occasional blockages. But still have a great time with my 2 daughters and husband!

Prednisone, 6MP,Prevacid, B12 shots, Bentyl, Xifaxan.....

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   Posted 3/26/2010 2:09 PM (GMT -7)   
C2 it is bleeding ridiculous what insurance co get away with imho...i think they believe majority of ppl dont bother checking out whats going on between who n whats being charged...lyn.
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Veteran Member

Date Joined May 2003
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   Posted 3/26/2010 8:05 PM (GMT -7)   
Yeah, but .... it doesn't sound or look to me like it was the insurance company. It seems to me it is the HOSPITAL saying insurance required the abdominal before the transvaginal each time. If the doctor's office doesn't have to do the abdominal before why should the hospital??
My computer says I need to upgrade my brain to be compatible with its new software.

Veteran Member

Date Joined Jul 2006
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   Posted 3/27/2010 10:48 AM (GMT -7)   
As you know my mother died of ovarian cancer at age 60. Please seriously think about getting a baseline CA-125 done (it is a blood test).
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Veteran Member

Date Joined May 2003
Total Posts : 9448
   Posted 3/27/2010 11:43 AM (GMT -7)   
Thank you, MMMNavy. Yup, we do run the CA-125 once a year. We know that the partial obstruction in the ileum is just sitting there waiting for a chance to force a second resection. I'm just biding my time and then we'll get both "birds" w/one stone (surgery). Whichever one gives grief first, we'll do both at the same time. And .... my lungs might "get me" befoe I need the surgery. Since I'm doing well, knock, Knock, KNOCK, why put myself thru the discomfort and recovery from surgery until I need to is my philosophy.
My computer says I need to upgrade my brain to be compatible with its new software.

Veteran Member

Date Joined Apr 2008
Total Posts : 1522
   Posted 3/27/2010 3:05 PM (GMT -7)   
My previous doc used to do the ultrasound in the office during my appointment requiring only one copay. My current doc requires me to make another appointment requiring another copay. They insist that my insurance company requires it that way. My insurance hasn't changed at all.

I left the old doc because he almost carelessly killed someone I know so I won't go back but I did call the office. They said that they were not required to schedule a separate appointment for an ultrasound.

Now I'm looking for a new doc (again) because those specialist copays add up quickly.

Veteran Member

Date Joined May 2003
Total Posts : 9448
   Posted 3/28/2010 4:43 AM (GMT -7)   
Ain't that a corker?? My ob/gyn doesn't require a follow-up office call for the US done in his office. Nor does he schedule an office visit w/him before he will schedule the US unless one is needed. He just routinely schedules that US twice a year - unless something new or disturbing were to show up on the US.

The U of KY has had an ongoing Ovarian Cancer Screening Trial since 1987. Up until just recently I was taking part in that at no cost to me or my insurance. For years I went to Lexington, KY the last full weekend in April for the Rolex 3 day Horse Eventing at KY Horse Park. I would schedule w/U of KY for the morning of the first day of the Eventing so I didn't have to pay for an extra night at the motel. Of course, that meant I missed the first morning of Dressage, but since there are two days of Dressage I didn't mind that too much as I got to watch the afternoon and the next day's Dressage. That way my insurance only had to pay for the one "set" of ultrasounds per year.
My computer says I need to upgrade my brain to be compatible with its new software.

Veteran Member

Date Joined May 2003
Total Posts : 9448
   Posted 3/28/2010 5:00 AM (GMT -7)   
I'd would like to clarify something. When that cyst was first found I immediatly hit the internet for info on post-menopausal ovarian cysts. There's little information other than HAVE IT OUT! Most information was on ovarian cysts in women of child-bearing years. I found ONE reference that said IF it was a SIMPLE cyst, waiting and monitoring until 8 cms was reasonable. I also found a Dr Belinson at Cleveland Clinic who is a gyn/onco w/a special interest in women w/IBD and "female" problems. I was able to make an appointment w/him w/in 10 days. He concurred we could monitor up to 8 cms if there were no symptoms and it stayed a simple cyst. My searches also brought up the U of KY Ovarian Cancer Screening trial. Since I was going to Lexington evey year anyway I contacted Dr Pavlik at U of KY to see if I would be eligible. It was reassuring to know I would be having professionals w/years of experience monitoring 1000s of ovarian cancer screening USs.

I do NOT advocate a post-menopausal women ignoring a symptomless ovarian cyst!!!!! It MUST be a SIMPLE cyst for one thing. Ovarian cancer is one of the less common cancers but it is DEADLY BECAUSE by the time they do cause symptoms it is usually TOO LATE so they are USUALLY found on a routine xray or CT scan for something else.

My computer says I need to upgrade my brain to be compatible with its new software.

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