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Post by Curious on Apr 6, 2015 18:19:36 GMT -5
What did you learn your out-of-pocket costs would likely be for the biopsy?
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Post by surprised on Apr 7, 2015 10:14:57 GMT -5
Diagnostic vs. "routine" screening: I have just encountered the hidden cost of routine screening noted by "Frankly" above: I was charged for the biopsy of a tiny polyp that was found during my first "routine" colonoscopy. I would have assumed that the examination of anything found during a routine test would be considered part of the cost of the screening itself. Apparently not. I can afford the $100 for the biopsy, but I'm sure there are many people who could not. I was not informed ahead of time that I would be charged for this. Given my (benign) family history, I would have noted the removal of one tiny polyp and opted not to do a biopsy. I'm now supposed to go back in 5 years (instead of 10), and I'm sure I will be charged for that procedure because they have now "found" something.
My question would be this: Was it intended that follow up from any initial findings from a "routine" screening should be considered diagnostic and thus would incur extra cost? Or is this an unintended loophole? I would love the believe the latter, but I fear the former.
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Post by nile080808 on Apr 17, 2015 12:43:21 GMT -5
Starting to choose between should I wait to see my Doctor to avoid the cost of testing verses should I get that prescription filled. The cost of getting tested to avoid a potential life-threatening diagnosis or get my Rx filled should happen to no one!!! How awful!
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Post by Still Curious on Apr 17, 2015 17:34:01 GMT -5
Again, I ask, what did you find out would be the cost for the biopsy?
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FrightenedForTheFuture
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Post by FrightenedForTheFuture on Apr 22, 2015 10:30:43 GMT -5
RE: breast biopsy
They couldn't give me a firm amount, as the biopsy can vary but they guessed my contribution about would be $750-$1500.
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Post by H2005 on Apr 23, 2015 6:25:03 GMT -5
Is $750-$1500 for a breast biopsy what the care provider(s) get paid or your out-of-pocket part of the payment? The out-of-pocket calculation for any procedure is your deductible ($250, less any payments that counted against your deductible this year) plus 10% of what the provider(s) will be paid. If the provider(s) will be paid $750 it would be at most $300 ($250 + $50) out of your pocket. If $750 or more is your out of pocket, that means the provider(s) are getting paid at least $50,000; that seems very high even if the procedure is performed in a hospital OR with full anesthesia.
If your out of pocket for a procedure is really quoted as $750 or more, that's when you're supposed to shop around. The point of a co-insurance health care model is to make the care recipient price conscious, not for choosing whether or not to have a test/procedure but to compare prices from different providers. There can be drastically different rates for the same service, especially between hospitals.
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Post by frankly on Apr 23, 2015 12:16:16 GMT -5
Just wanted to point to a minor math problem in the post above from H2005. The extimated out-of-pocket obligation of $750 would reflect a total billing for the care of $5,250 (Not $50,000 as suggested in the last comment). On an episode of care (surgery or diagnostics or both) with a total billing amount of $5,250 the first $250 would be the patient's obligation as a deductible for the year. The remaining $5,000 would be subject to 10% coinsurance adding another $500 to the $250 deductible, for a total patient out-of-pocket cost of $750. Using the same logic and arithmetic, total billings of $12,750 would result in a patient cost-sharing obligation of $1,500. So the range of possible patient contributions that FrightenedForTheFuture refers to would reflect an assumption that the total billing for surgery and diagnostics on the biopsy would be $5,250 to $12,750. Is that a surprisingly high estimate? I don't think so. Check out some of the stories and descriptions of itemized costs (from different parts of the country) on this website: community.breastcancer.org/forum/113/topic/755580 It looks there as though, for a surgical biopsy, it's not unusual to have billings of $5,000 - 7,000, and that's just for the surgical procedure. The lab work and separate pathologist's fees could be a few thousand more. The differences in price between different hospitals and providers are not really in play here. The kind of price differences we see in Eastern Massachusetts might cause a surgical breast biopsy to cost $8,250 at one facility and $10,250 at another. But for the patient that's just a choice between paying $1,050 or $1,250. There are some plan designs that give patients strong incentives to make price-conscious decisions. The 2015 Harvard plan is not one of them. In the case of FrightenedForTheFuture and a lot of other Harvard employees, it really is just a decision about whether she can afford to have the critical preventive care and peace or mind, or she can't. |
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Post by emilybronte on Apr 23, 2015 14:42:11 GMT -5
I would like to take a slightly different twist away from the very important issue of the cost and shopping for the best price. That is, what "price" do you place on trust. For example, if you have been using the same clinic for diagnostic testing for the last 7 years, a place you trust and where all your various scans, images, X-rays, etc reside, why should you have to ponder changing clinics to avoid a higher price tag.
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Post by H2005 on Apr 24, 2015 6:12:39 GMT -5
frankly, thank you for the correction, I can't believe how badly I screwed the math up. If I had done it correctly, I wouldn't have batted an eye at a surgical biopsy possibly being in that cost range. Still, a $200 out of pocket difference is significant.
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FrightenedForTheFuture
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Post by FrightenedForTheFuture on Jun 10, 2015 17:42:39 GMT -5
Got my my bill for just the mammogram(no biopsy yet, have to save up for it) done over at health services. It's high enough to raise some eyebrows. If there is any interest, I'll scan it in and remove any identifying details.
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Post by Dense Humor on Jun 15, 2015 10:36:10 GMT -5
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Post by Sad but True on Jun 16, 2015 10:58:05 GMT -5
That is a brilliant piece! Thanks for sharing. Head shakingly accurate.
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FrightendForTheFuture
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Post by FrightendForTheFuture on Jul 23, 2015 20:20:43 GMT -5
Well, I still haven't gotten the biopsy. The costs are just too high for me: the mammogram alone was $200+ For my contribution . I'm waiting until next year. I hope that plan will change and if not, take a part time job that has better healthcare benefits. Sad but true. I case anyone else is in a situation like me and cannot afford to use my Harvard sponsored insurance, here is a list of part time employers with good benefits: www.moneycrashers.com/part-time-jobs-health-insurance-benefits/ |
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Post by Reader on Jul 25, 2015 7:55:34 GMT -5
All but one of the places in this article have worse - in most cases much worse - than Harvard coverage. Non subsidized, no family coverage, very limited networks, much higher deductibles and co insurance, etc., etc.
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