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#53194 02-12-2007 09:18 AM
Joined: Nov 2005
Posts: 1,128
Pete D Offline OP
Patient Advocate (1000+ posts)
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Patient Advocate (1000+ posts)

Joined: Nov 2005
Posts: 1,128
Here's the financial damage from my PET/CT scans, for which I just got the bill. BTW, it was a combined PET and CT scan (skull base to mid-thigh per my request for a full-body scan), also called a "Fusion" because of the software linking the two scans. I don't know what the cost would have been for a shorter set of scans.

Billed price for scans: $3050.00
Billed price for Doc report: 500.00

less network discount for scans: -363.65
less network discount for Doc: -250.00

Total 2936.35

My share, under 80%/20% plan $587.27

In this case, my cost is actually somewhat higher because I have not met my annual deductible, but I chose to exclude that because it is really a timing event and dependent on other services I may or may not have paid year to date.

For those who may not know what a 'network discount', that's an agreed price reduction from the 'list' price of the service between the insco and a 'preferred provider'.


Age 67 1/2
Ventral Tongue SCC T2N0M0G1 10/05
Anterior Tongue SCC T2N0M0G2 6/08
Base of Tongue SCC T2N0M0G2 12/08
Three partial glossectomy (10/05,11/05,6/08), PEG, 37 XRT 66.6 Gy 1/06
Neck dissection, trach, PEG & forearm free flap (6/08)
Total glossectomy, trach, PEG & thigh free flap (12/08)
On August 21, 2010 at 9:20 am, Pete went off to play with the ratties in the sky.
#53195 02-13-2007 03:09 PM
Joined: Nov 2002
Posts: 3,552
Patient Advocate (old timer, 2000 posts)
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Patient Advocate (old timer, 2000 posts)

Joined: Nov 2002
Posts: 3,552
I am sure glad that I have Kaiser. I pay 50 bucks for any type of scan except chest x-rays which are 10 bucks. The reading/report is free.
Doctors visits are 5 bucks as are generic meds (name brand 15bucks). ER, as I found out last Sunday, is 100 bucks. It does almost $1500/mo for my wife and I...


Gary Allsebrook
***********************************
Dx 11/22/02, SCC, 6 x 3 cm Polypoid tumor, rt tonsil, Stage III/IVA, T3N0M0 G1/2
Tx 1/28/03 - 3/19/03, Cisplatin ct x2, IMRT, bilateral, with boost, x35(69.96Gy)
________________________________________________________
"You are a mist that appears for a little while and then vanishes" (James 4:14 NIV)
#53196 02-14-2007 01:30 PM
Joined: Jan 2004
Posts: 316
Platinum Member (300+ posts)
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Platinum Member (300+ posts)

Joined: Jan 2004
Posts: 316
Boy, we must have it lucky 'Down Under'. My PET/CT was covered by the government as it was done in a hospital. Not one cent did I pay!

If procedures are done outside a hospital, say a private clinic, yes I have to pay. A CT costs around AUD$400, and Medicare gives some rebate, though not as much as I'd like frown

Cheers!

Tizz (who does not know how long this system will be so kind)


End of Radiation - the "Ides of March" 2004 :-)
#53197 02-15-2007 03:00 PM
Joined: Nov 2005
Posts: 1,128
Pete D Offline OP
Patient Advocate (1000+ posts)
OP Offline
Patient Advocate (1000+ posts)

Joined: Nov 2005
Posts: 1,128
If I'd been on a HMO plan and IF I could have talked my Doc into getting the full-body scan, likely the plan would have paid for the whole thing.

I have chosen the plan I have because it gives ME the choice to go outside the PPO (preferred provider organization) if I choose and still have coverage, albeit without the in-network discounts and still having to pay the 20% (up to $2,000 out-of-pocket per year, BTW, after which the insco pays it all -- That happened in the calendar year in which I started surgery/rad -- I paid $2K and the insco paid more than $30K). I have the insurance to cover the really big stuf -- $600 isn't a trivial amount until one compares it to $30K!!

For example, if going to a CCC was NOT on the insco's list of providers or within the guidelines of local HMOs, I still had the choice to go anyway and be covered after $2K out-of-pocket -- In fact, I could exercise choice to choose among ALL the US CCCs to use the best!

Things are not always what they seem to be at first!


Age 67 1/2
Ventral Tongue SCC T2N0M0G1 10/05
Anterior Tongue SCC T2N0M0G2 6/08
Base of Tongue SCC T2N0M0G2 12/08
Three partial glossectomy (10/05,11/05,6/08), PEG, 37 XRT 66.6 Gy 1/06
Neck dissection, trach, PEG & forearm free flap (6/08)
Total glossectomy, trach, PEG & thigh free flap (12/08)
On August 21, 2010 at 9:20 am, Pete went off to play with the ratties in the sky.
#53198 02-15-2007 10:34 PM
Joined: Nov 2002
Posts: 3,552
Patient Advocate (old timer, 2000 posts)
Offline
Patient Advocate (old timer, 2000 posts)

Joined: Nov 2002
Posts: 3,552
Even in an HMO they can sometimes refer you out. Kaiser picked up the entire cost of my RO and treatment at UCSF CCC. I also had one of the best RO's in the US. I didn't even have a copay - not even for CT's done at the CCC


Gary Allsebrook
***********************************
Dx 11/22/02, SCC, 6 x 3 cm Polypoid tumor, rt tonsil, Stage III/IVA, T3N0M0 G1/2
Tx 1/28/03 - 3/19/03, Cisplatin ct x2, IMRT, bilateral, with boost, x35(69.96Gy)
________________________________________________________
"You are a mist that appears for a little while and then vanishes" (James 4:14 NIV)

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