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Billed cost of treatments (chemo, CT-scans, PETs, radiation, Neulasta)??

lindaprocopio's picture
lindaprocopio
Posts: 2022
Joined: Oct 2008

I'm just curious what everyone's insurance is billed for various treatments. My insurance had been paying pretty good, aside from my crazy-high deductible, but I am shocked at what they are billed for each treatment. Each round of carbo/taxol was billed at close to $16,000. Each CT-scan was billed at approximately $11,000 including review of the scan. I didn't get my bill for that single Neulasta shot, but was told it would be around $7,000. The radiology technician told me that the combo PET/CT scan is billed out at about $25,000 a pop, when I asked what it would cost if my insurance wouldn't pay it and I wanted one. Because I am self-employed and have private insurance, I opted for huge annual deductibles (and paid the deductible in 2008 and again in 2009) to keep my monthly premiums reasonable, and then I had my surgery 'out of network', I've paid about $20,000 out-of-pocket so far. But my insurance has already paid hundreds of thousands. No wonder we cancer patients get free valet parking at the hospital and have our own gated parking lot at the clinic! We're talking 'big money' here!

Is what my cancer center bills in line with what the rest of you are invoiced for the same treatments?

shortmarge's picture
shortmarge
Posts: 295
Joined: Nov 2008

It's crazy trying to figure everything out.

Nov. chemo bill was $10,516.47 - my insurance company paid $ 5,089.97.
Dec. chemo bill was $31,917.90 - my insurance company paid $15,448.27.
Jan. chemo bill was $ 4,250.70 - my insurance company paid $ 1,934.09.
My CAT scan was $6,910.80 - my insurance company paid $ 3,144.41.
CAT radiologist reading bill was $758.00 - my insurance company paid $429.51.
My 3-1/2 day hospital stay (hospital not surgery) was $27,933.82 - my insurance paid $15,452.25.

jankenb's picture
jankenb
Posts: 28
Joined: Apr 2009

Each of my carbo/taxol are about 7000, however that includes the 3000 dollar Eloxi and the 3000 dollar neulasta
The cost to the hospital I work at for a vial of neulasta is 3100.
the actual carbo taxol are actually cheap, they are around 3hundred dollars each.
My PEt was 3900 and the ct was 2500

The interesting thing about the IMRT is that my oncologist explained to me that studies have shown a very small subset of people who utilizing IMRT in the pelvis makes any difference to the area irradiated. It is used extensively because the oncologists can BILL so much more for it than 4 beam.
You seem to be about triple of us out west

bonniesue
Posts: 126
Joined: Apr 2009

Hi- I am wondering if you could elaborate on why the IMRT is used--your onc said it does not help the area of poterntial reoccurrence?? because my mom had the grade1 stage 1C or 2B and had greater than one half of myometrium invaded and lower uterine segment. She did have the gyne onc saying just brachytherapy since low grade and the rad onc saying she needed both IMRT (25X) and brachy. I got a second opinion and they said they might to 4 beam and she would need brachy. called someone down at another institiution and he said just brachy if it was his mom. I do not want her to have a pelvic reoccurence but I am scared of the side affects. I know you said you are in the medical field. I would really appreciate if you could give advice as I would hate for her to go through this just because it pays better...ouch!!No one recommended chemo for her.bonniesue

bonniesue
Posts: 126
Joined: Apr 2009

My concern is your onc saying that IMRT helps only a subset and they can bill for it. My mom's rd onc said today that maybe he would do just 27 IMRT and skip the brachytherapy? I thought brachytherapy was important to prevent vaginal cuff recurrence. also seems he now is having a resident see her on weekly visits after setting her up and is gone on the days(out of town) of her appointments? also techs markings are different than tattoos.He said not a big deal and they draw an X no where near the tattoos after setting her up in a cradle. I am sick of the medical field as of today. Anybody besides Jankenb-responded earler to her above comment. Hope you are ok.

daisy366's picture
daisy366
Posts: 1493
Joined: Mar 2009

I have stage 3a UPSC and my doc recommended NO radiation. He said that recurrence in the vaginal cuff is very curable and not worth the risk of radiation. If you check the NCCN guidelines, there is room for lots of variation in treatment. You and your doc make the call. Mine, I guess, is conservative and he believes there needs to be "more science" for him to recommend some treatments at least for me.

I also did not get one neulasta shot during my chemo, thank goodness for me and the cost of treatment. I hope someone is considering the pocketbook since WE ARE ALL PAYING for these high costs in the long run.

lindaprocopio's picture
lindaprocopio
Posts: 2022
Joined: Oct 2008

I don't know how they get away with it! Geisinger does seem to pride themselves on having the latest-and-greatest medical technology gizmos, and I guess they need to use them to get them paid off. I sat across from a man who didn't have insurance and had signed that paper saying he'd pay, and he told me that the chemo they were pumping into his arm that day was $40,000. He said he'll have no choice but to quit his job and go on Medical Assistance, even though his family's standard of living would go way way down. I used to sit at chemo and do the math, assuming each of the 50 people getting chemo concurrently with me were paying an average of $10,000@, and assuming each 'chair' would be occupied twice each day, that's a cool $1 million gross per day, day after day, just for chemo. wow.

MARGE: Did your cancer center accept what the insurance was willing to pay as 'paid in full'? Hope so!

shortmarge's picture
shortmarge
Posts: 295
Joined: Nov 2008

Yes, they did. The only thing I have had to pay is my $750 deductible and doctor co-pays. $40 each visit to the oncologist. I feel very blessed that I have excellent insurance.

Ro10's picture
Ro10
Posts: 1390
Joined: Jan 2009

I had my first three chemo treatments in Florida, and each one was around $4000. I think you pay for the amount of time you are in the chemo chair, as I have 4 different "therapy charges". I am in the chemo chair 8 - 9 hours each day. I saw the doctor and had lab the day before the 2nd and 3rd chemo treatments so these were additional charges. Insurance has paid around $2000 for each chemo treatment. I too have a high deductible ($10,000) which was met by the middle of February. We chose the high deductible because we have never used the insurance before, except to have two kids. That is why I asked for the surgery to be in January rather than December 29th to avoid the two deductibles.
The charge that gets me the most is for my hospital stay overnight after my Robotic Hysterectomy was $34,307. That did not include anesthesia, pathology or the surgeon's charges. The insurance allowed $1507 on the hosptial stay. How can that be? So far the hospital has accepted what ever the insurance allowed. The anesthesia and surgery were billed about $11,000, and insurance paid about $4800.
I am anxious to see how these radiation treatments are billed. I will be getting my last 3 chemo treatments in Illinois, so it will be interesting to see how their charges compare with the Florida charges.
I am just glad we have 100% coverage after the deductible is met.

deanna14
Posts: 733
Joined: Oct 2008

I can't even figure out what the heck the insurance company is doing with my bills. Looks like the hospital is just now submitting bills to insurance from the D&C that I had last July. From what I can tell they are billing everything in 2008 and 2009. My catastrophic maximum out of pocket is $5000.00 and my portion of the bills lacks about $700.00 from being there. That will be taken care of on Monday when I get chemo #5! If I understand, I shouldn't have to pay for anything else out of pocket for the rest of the year?!

I just keep putting everything I receive in a file folder in the file cabinet. It is overwhelming to think about and I just want to concentrate on getting well. I pay the smaller bills when they come and the larger bills, I send them $50 and go on. I guess I will pay it off eventually.

lindaprocopio's picture
lindaprocopio
Posts: 2022
Joined: Oct 2008

Peggy posted here once that her total UPSC cost of treatment over the 2 years ended up being $1.5 million, most covered by insurance. (I MISS Peggy! Has anyone heard from her?) I try and leave all the insurance haggling to my poor husband, as I just can't let that add to my stress. I remember how awful I felt when my cell phone rang while I was getting chemo, and it was the hospital's financial department freaking out because the new year had started and they didn't have my 2009 $7,500 deductible. I said "Did you BILL me for it? (they hadn't!) "because I am currently hooked up to an IV and can't check on that for you now!" He seemed much more upset that I was getting an expensive treatment and he didn't have my new-year deductible than he seemed to be for having disturbed my chemo infusion. My husband was livid. We had to do an electronic $$ transfer as soon as we got home, and no one ever DID send us a bill for the deductible.

When we got our annual health insurance renewal, our monthly premium went up $150. But that was much less than we expected. You are really at the mercy of your insurance company when you have private insurance. We worried that they would DOUBLE our monthly premium in an attempt to get us to drop the coverage, and were grateful that the premium only went up $150/month. Because I think that NO ONE else will ever be willing to cover me again. I had to laugh when a Highmark/Blue Cross saleman working out of our local Chamber of Commerce called to sell me health insurance for my business. When I told him I was currently in treatment for cancer and asked if he was still interested in getting me a quote, he got REALLY quiet, then said he'd have to get back to me. And when he finally called me back 2 weeks later, he said they wouldn't have any plan he could offer me. I guess I'll stick with my 'Assurant Health'; they've been fair with me so far.

susie1143's picture
susie1143
Posts: 109
Joined: Aug 2009

Since I previously worked for an insurance company, hospital and doctor's office I am well versed in this area. First of all it depends upon your policy: (HMO, PPO or the old standard usually 20/80). With the HMO you need that authorization or you will be responsible for the whole balance. With an auth, you should only pay your copay. Now a PPO no auth is required and you have choice of in or out of network. This gets tricky with a surgery. Your doctor may be in-network but the hospital and any other doctor (ie: radiologist) may be out-of-network. The old standard is a yearly ded than the patient is responsible for 20% of the UCR (Usual Customary Rate) and the insurance pays the balance of the UCR. Once you meet your out of pocket (the most you would be responsible for your calendar year or contract year) the insurance pays the balance of the bill.

Now let me explain about the UCR that most people do not know about. This is considered the usual customary rate that the insurance will pay for a particular service within a geographical area. I actually saved a friend approx $1,000 because physical therapy was balance billing. This is when the provider (hospital,dr, etc) will bill the difference of the amount allowed by the insurance and the actual billed amount. Be careful of this it happens very often and is actually against the contract with the insurance companies. If you have any questions regarding your amount due, call your insurance company ASAP. Also, every month look at your EOB (Explanation of Benefits) that you receive from the insurance. This will tell you the total amount billed, amount allowed (UCR), amount paid and amount that the patient owes. If the provider is in network you do not owe any more money than on this statement.

It's amazing the amount that hospital bills the insurance company but most of it is written off since almost always it's well above the UCR. As far as self-pay, some hospitals will offer reduced amounts, payment plans and if non-profit they will write off the total amount owed. You really need to speak with a financial counselor at the hospital and doctor office to see what they offer. I also used to do payment plans at a medium size chain of hospitals. If someone really could not pay, I would refer them to the department who reviewed case by case to help with the expenses. Just keep in mind not all hospitals offer this and once you sign you are expected to pay.

Another part of insurance that is important is how the claim is billed. A big example would be mammograms. My Mom is on Medicare and in remission from breast cancer. Since she need mammograms as part of follow-up it is billed as a procedure not as a physical. This is important for those on Medicare since they don't allows cover physicals. As far as private insurances, this is important since sometimes your policy only allows so many mammograms/blood tests/bone density tests, etc in a year for physicals. This can be frustrating because if the bill is submitted in-correct many doctor offices will not re-submit with the correct codes.

And lastly is the pre-existing conditions. This varies from company to company if through a business and of course insurance to insurance. If you start a new job many times the pre-existing clause will be waived. Most pre-existing clauses look at the 3 months prior to getting a new policy. I'm actually going though this myself with short-term disability. Since my policy began in Jan 2009, they will look at my records from Oct 1-Dec 31 2008. If I was not seen for this particular diagnosis, then it is not pre-existing and I will be paid. I'm not sure if you private pay for insurance if this affects your monthly premium or if the insurance looks at a longer time period.

I hope this helps.
Susie

Songflower's picture
Songflower
Posts: 632
Joined: Apr 2009

My chemo day was billed for about 10,000 but the insurance company paid 2500 by some arranged agreement. I got five meds IV before carbo plat. What I am struggling with now is I carry the health insurance; I would like to go back to work part time but then cannot get health insurance. My husband carries Cigna so will sign on for Cigna in Nov to kick in Jan 1. Apparently you are covered if you were covered by another insurance. I hope this is correct. The entire thing scares me to death; I would like to work part time with this diagnosis but so afraid of losing my good health insurance (I have optima). We would have to go to Cigna.

Linda, I don't understand why you could not go on your husbands insurance, wait the six months for pre-existing condition to be waved.

Our current system seems to work if you don't get sick. Worrying about all this is something cancer patients don't need!

susie1143's picture
susie1143
Posts: 109
Joined: Aug 2009

When you change insurance due to going part-time it's called change of life. This is usually due to loosing benefits because of job loss or status, having a child, divorce. Before you go on your husband's insurance, contact the employee benefit person and verify that pre-existing is waived. Most large companies do determine their own benefits and the insurance company oversees the benefits.

Sue

california_artist
Posts: 850
Joined: Jan 2009

OOOOOOOOOOOOOOOOOWWWWWWWWWWWWWWWWEEEEEEEEEEEEEEEEE Baby!

That's some hot outfit.:~ 0

susie1143's picture
susie1143
Posts: 109
Joined: Aug 2009

I'm a professional clown and my clown name is "Lilly". I do mostly volunteer work as Lilly. When I first diagnosed and was told Grade 3, I joked and said that I would go as "Lilly" if I lost my hair. That way I would bring some joy into other lives.

Susie

california_artist
Posts: 850
Joined: Jan 2009

Dear Susie,

Absolutely love your spirit.

Warm regards,

Claudia

Songflower's picture
Songflower
Posts: 632
Joined: Apr 2009

I am giggling at your last comment about what's that scar...uh.... hernia! I think there needs to be some safety net in our society for people who have serious illness such as cancer, Multiple Sclerosis, etc. We expect people to work through chemo and radiation as if it is just a blip in their life. I realize I had a reaction to taxol so it was worse; but come on, it's no picnic for anyone!

There are still some nice guys out there.......so if one knocks I hope you will at least open the door a crack and talk to him. He would be lucky to get you.

Diane

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