Whoo Hoo What a bill!

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lowandslow
Regular Member


Date Joined Jan 2011
Total Posts : 122
   Posted 4/12/2011 11:40 AM (GMT -6)   
I just added up the provider charges from diagnosis through ed device. $77,724.19. Insurance hasn't finished adjusting on the largest of the charges yet, but so far their payment has been about 30% of charge.  Thank God for in-network providers.
Age 48
PSA 4.1 No symptoms
Diagnosis 1/12/11
RRP 3/14/11
Gleason 7 (3+4)
T2c
Margins clear
Seminal Vesicles clear
Lymph nodes clear
Prostate 69.5 grams
Organ confined
9% involvement

clocknut
Veteran Member


Date Joined Sep 2010
Total Posts : 2667
   Posted 4/12/2011 11:49 AM (GMT -6)   

That's a lot of money, Low.  Just for comparison sake, you could have used that money to buy a low-end BMW 7-Series. tongue

I think my total bill ran a little over 90 thousand, and as you say, thank goodness for insurance.


davidg
Veteran Member


Date Joined Feb 2011
Total Posts : 4093
   Posted 4/12/2011 12:37 PM (GMT -6)   
you had surgery a month ago but already have an ed device? what am I missing here?

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3742
   Posted 4/12/2011 12:52 PM (GMT -6)   
Why do providers calculate bills at say $90K when they KNOW they are only going to get $30K and be happy with that...? There is something WRONG with a system that demands three times the money from the self-insured..
Age 68.
PSA age 55: 3.5, DRE normal.
age 58: 4.5
61: 5.2
64: 7.5, DRE "Abnormal"
65: 8.5, " normal", biopsy, 12 core, negative...
66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
67 4.5 DRE "normal"
68 7.0 3rd biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT. 2-15-'11 PSA 0.0

lowandslow
Regular Member


Date Joined Jan 2011
Total Posts : 122
   Posted 4/12/2011 1:05 PM (GMT -6)   
The medical field is definitely NOT a free market system as some like to think. More like a system of mini-monopolies. Competition is non-existent. As far as the ED device goes, they had me take it with me at catheter removal.
Age 48
PSA 4.1 No symptoms
Diagnosis 1/12/11
RRP 3/14/11
Gleason 7 (3+4)
T2c
Margins clear
Seminal Vesicles clear
Lymph nodes clear
Prostate 69.5 grams
Organ confined
9% involvement

davidg
Veteran Member


Date Joined Feb 2011
Total Posts : 4093
   Posted 4/12/2011 1:10 PM (GMT -6)   
what exactly is the ed device though?

I think there is a ton of competition on the field. I was stunned to learn this, but the way the radiation guys go after the surgery guys and vice versa is really evident.

clocknut
Veteran Member


Date Joined Sep 2010
Total Posts : 2667
   Posted 4/12/2011 2:29 PM (GMT -6)   
Fairwind, my wife and I had a frank and interesting conversation with a neurologist last winter about billing.  She did a nerve conductivity study and a couple of other tests at her office and came right out and told us she would be billing a certain standard amount (a lot), but that she knew in our case Blue Cross/Blue Shield would negotiate it down to a fraction of her billed amount.  She said that she really doesn't make much money on folks like us, but she does get other customers that involve on the job injuries, lawsuits, or other situations where she receives the billed amount.  Overall, it balances out and she's able to pay her bills and make a comfortable living.  That's why she bills $800 for a test, knowing she'll only get maybe $200 from the insurance company.  Once in a while, she gets the whole $800.  Does that make sense?

davidg
Veteran Member


Date Joined Feb 2011
Total Posts : 4093
   Posted 4/12/2011 2:55 PM (GMT -6)   
My urologist told me I would be billed $2000K for my biopsy and he billed the insurance company $7500 for it! My surgeon billed me less for the robotic procedure because I wasn't covered with him.

DaSlink
Veteran Member


Date Joined Feb 2011
Total Posts : 713
   Posted 4/12/2011 3:02 PM (GMT -6)   
I had my ED device 4 weeks before surgery. My surgery was around $50k. I had to pay $2500 out of pocket and from here on out $0.
Every minute you fish or ride,adds an hour to your life!

Age 52 Dx age 53 daVinci surgery
prostate volume 32 grams
Biopsy 12 cores with 7 positive
Gleason score of 7
1st PSA 38.7 10/05/2010
2nd PSA 49.9 11/23/2010
CT neg.
BS Negative
RRP on 01/25/2011
PT3a -40% involved
margin involved-Left anterior
lymph nodes -clear
1st post op PSA-0.26-03/16/11

lowandslow
Regular Member


Date Joined Jan 2011
Total Posts : 122
   Posted 4/14/2011 4:15 PM (GMT -6)   
Davidg, It is a vacuum pump. I signed a form during the consult at catheter removal that I would make up any difference in payment under 500 dollars. The doc billed 1000, insurance paid 476.24 and sent me notice that my share was 109. Nope, I will pay 23.76 and they can eat the rest. I used it one time (yesterday) and discovered I could get the same result without the pump. Not an age 16 erection,but as good as I had pre surgery. I was pleasantly surprised by that. I have ADC viagra but havent used it. The fact that I am on plavix for a previous heart attack makes me somewhat nervous about viagra or other ed meds.
DaSlink, my out of pocket max has also been reached. As soon as I'm able Im getting a bunch of testing done heartwise etc. I'm gonna use my insurance for all it's worth for the rest of the year.
Age 48
PSA 4.1 No symptoms
Diagnosis 1/12/11
RRP 3/14/11
Gleason 7 (3+4)
T2c
Margins clear
Seminal Vesicles clear
Lymph nodes clear
Prostate 69.5 grams
Organ confined
9% involvement

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 4/14/2011 5:21 PM (GMT -6)   
davidg - you were charged 2,000K for a biopsy, that's 2,000,000 dollars. that's some doctor's fees, lol
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 2/11 1.24
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 9/10,

davidg
Veteran Member


Date Joined Feb 2011
Total Posts : 4093
   Posted 4/14/2011 5:41 PM (GMT -6)   
Oh, ok.

Heart attack and cancer by 48, what the hell?

I wouldn't take ED pills either in your case.

I don't really buy it, but there are plenty of guys who claim to get erection with natural herbs and all that alternative stuff. Perhaps you can try that.

lowandslow
Regular Member


Date Joined Jan 2011
Total Posts : 122
   Posted 4/15/2011 7:18 AM (GMT -6)   
I've always said I'm running 25 years ahead of schedule. The youngest city water superintendent in Ohio at 34, the youngest city manager in Ohio at 37, 2 heart attacks at 40, retirement at 42, PCa at 48. I hope I make it to 60 LOL.
Age 48
PSA 4.1 No symptoms
Diagnosis 1/12/11
RRP 3/14/11
Gleason 7 (3+4)
T2c
Margins clear
Seminal Vesicles clear
Lymph nodes clear
Prostate 69.5 grams
Organ confined
9% involvement

Rolerbe
Regular Member


Date Joined Dec 2008
Total Posts : 235
   Posted 4/15/2011 9:47 AM (GMT -6)   
Clocknut, It certainly does not *make sense*, but the way ti works is that the insurance companies negotiate to pay a fraction of what *they* determine to be 'reasonable and customary' (R&C). The only way the MD's can keep that actual insurance reimbursement at a level they can afford to take is by having their posted rates way above. Otherwise the R&C keeps sinking lower and lower.

The kicker is that if you come to the MD NOT on insurance, they are required by law to bill you the full posted rates. They cannot cut you a break to make it closer to the insurance reimbursed rates, etc. So, it reinforces the stranglehold that Medicare and the insurance companies have on the system. Kindof like Congress voting on their own raises (statement NOT intended to take this in any political direction). Third party payment systems are trouble. But like is said about democracy, its the worst possible system -- except for all the others.
age 52
RALP 10/08
One nerve spared
Gleason 7 - T1c
Pre op PSA 8.2 -- first PSA ever taken at age 50 physical
Most recent PSA 0.02 (12/10)

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3742
   Posted 4/15/2011 10:27 AM (GMT -6)   
"The kicker is that if you come to the MD NOT on insurance, they are required by law to bill you the full posted rates.

What law?? What "posted rates"??

Seems to me they all charge whatever they can get away with, and many of them make billing adjustments for their uninsured cash customers..

Rolerbe
Regular Member


Date Joined Dec 2008
Total Posts : 235
   Posted 4/15/2011 11:08 AM (GMT -6)   
I can't say that none of them ever do it, and 'Law' might have been too strong a word, rather it breaks the contract they have with the insurance providers, for which the insurance providers (and Medicare being the biggest) have legal recourse.
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