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  • Decreasing out of pocket for surveillance.

    I have a PPO and I receive my surveillance at Stanford Medical Center. Due to my 10% out of pocket expense plus a $250 deductible my bill is just under $3000/year. The case worker at my insurance has suggested a "stand alone imaging center" and labs at Quest or Lab Corp because the billing agreement is less. Then I would share them with my oncologist instead of having my CTs and labs at Stanford.
    Should I have any concerns that all my diagnostics don't fall under one roof? Anyone have other suggestions? I have to reduce some costs my insurance premium contribution also went up $4000 for this year as a company-wide cost saving measure.

    My insurance is Cigna/ Great West Healthcare and I have a Flex Spending Account. I am getting through the FSA pretty fast due to other family costs.
    08/07/10 Found out my wife was pregnant with our first child
    09/13/10 U/S revealed mass
    09/18/10 Left I/O - 100%- seminoma
    -Surveillance
    03/10/11 first-all clear
    04/21/11 My son was born!

  • #2
    With a $250 deductible, I would think you out of pocket maximum is low as well. Do you know what that $$ amount is?

    Imaging center should work, just make sure they are "in network" other wise it will come out of a seperate out of netwrok deductable.

    Have your scan done a fews days before your appt. then drop of the disk in advance to your onc. That should give them time to review the scans. Check also that there isn't a "Consult fee" with your radiology dept. or if they would roll that into your visit cost. (Co-pay)


    Let us know what you find.

    John
    sigpic
    Diagnosed 4/17/08
    Right orchiectomy 4/18/08
    Pure choriocarcinoma; HCG 715,000; lungs, lymphnodes, liver, and random other places
    4X VIP chemo at IU with Dr. Einhorn 4/25/08-7/4/08
    HCG down to 7.2 10/28/08
    HCG back up to 198 12/29/08
    1 X PVB 1/2/09-1/6/09
    2 X HDC w/ stem cell rescue 2/4/09-3/14/09
    Follow-up with Dr. Einhorn 4/22/09
    HCG 1.2
    3 rounds, 21 days, twice daily, VP-16 50mg 4/24/09-7/10/09

    http://www.caringbridge.org/visit/johncovell

    Comment


    • #3
      I agree with John. The biggest hassles are the extra trip and making sure the images and report get to your oncologist on time.
      "Statistics are human beings with the tears wiped off" - Paul Brodeur
      Diagnosis: 05Sept07 Right I/O: 13Sept07; Pure Seminoma; Surveillance only per NCCN: All Clear August2013 (CT scan, Markers)

      Comment


      • #4
        My max is $3000/6000 ind/family so I'm almost there but can you blame me for trying to avoid any costs that I can.

        I appreciate the help guys. I just wanted to pole the crowd and see if this was difficult for anyone. I totally understand the in/outs of insurance it seems with a bit more logistics I earn a $1600 savings. John, the radiology consultation is a good point and I will check into that with my oncology case worker.

        p.s. Paul- You answered my bicycle saddle question. The problem is getting solved with snuggie underwear and a wider saddle (model: specialized henge, I tried 7 saddles) Thanks for your help with that too.
        08/07/10 Found out my wife was pregnant with our first child
        09/13/10 U/S revealed mass
        09/18/10 Left I/O - 100%- seminoma
        -Surveillance
        03/10/11 first-all clear
        04/21/11 My son was born!

        Comment


        • #5
          I've been thinking about this as well. Since I know my surveillance schedule each year, and I also know my deductible and OOP max, I figure I should be able to ballpark my costs pretty well. My appointments and the bloodwork at the onco's place is just a co-pay, but those CTs are expensive! My understanding is that I could set aside money in an FSA or HSA to pay for that tax-free, right?

          Also, my insurance says that anything, anything at all, that's done at a "specialist's office" is not subject to my deductible/OOP and is simply a $40 co-pay. Previous examples include $40,000 worth of chemo. I wonder if there is an outpatient standalone radiology or imaging place that my insurance would consider to be a "specialist's office"? I'd fee stupid paying $2000 for something I could pay $80 for (2 CTs) if it was just a matter of semantics.

          Comment


          • #6
            It's interesting how everyone's insurance can work so very differently. My husband has BCBS with a point of service. So, he does not do ANY imaging at his oncologist's or urologist's offices, even though they have those services on site. He does all his scans off site at a radiology center. The onco or the uro sends the order to the radiology center ahead of time, and then they send the scans directly to the onco and/or uro. The only testing he has done on site is blood work, at this point.
            So, coming from that perspective, yes, it is often a pain, because sometimes they don't send the stuff to BOTH doctors, and we have to go get the disk and send it to the uro ourselves. Which is a pain, but cheaper, because there is no "office visit" co pay for the radiology services. There is an imaging service copay, but it applies to the balance after the insurance pays their 80%, so it's not just "lost money" like it is when it's an office copay. We end up paying somewhere around $350 out of pocket for each set of scans (CT, x-ray, and U/S).
            Also remember that if you spend enough out-of-pocket on medical costs, you can deduct it on your taxes! I believe the current rule is based on percentage of income.
            Best wishes,
            Kat
            sigpic_______________________________________________
            Caregiver
            DX 5/15/09
            Left orchiectomy 5/22/09
            60% embryonal, 40% seminoma, w/ VI, LI, T2 (CS-IB)
            CTs clear, X-rays clear, blood markers normal
            L-RPLND 7/14/09, San Antonio
            3 nodes positive, 100% embryonal, N1 (PS-IIA)
            2 rounds BEP August 24, 2009, Austin
            Enlarged lymph nodes Oct 09, Dec 09, Jan 10, Apr 10
            All clear 10/01/10

            Comment


            • #7
              Kat - very strange indeed how it all works differently. I have BCBS too, albeit out of Illinios (I work for a Chicago-based company). I've only ever had CTs done at a hospital, once because I was in an accident and once because I was having the I/O the next day and it was 7 PM and they needed it done stat. So I've never had a CT with prior warning. Before my first surveillance CT in a couple months, I really want to call around and see if I can work the system in some manner to get it to where I'm paying a little less doing it somewhere other than a hospital. Although, that said, I just burned through my OOP max on a hernia op a couple weeks ago, so it doesn't matter for this year anyhow!!!

              Comment


              • #8
                Just a thought and I don't know how valid it is: my husband's oncologist is switching the location of her practice from Duke University Medical Center (DUMC), to a satellite hospital in Raleigh owned by Duke. For his follow up CT scan in June, she suggested that at least for this one follow up CT that my husband continue to be scanned at DUMC instead of the new facility. Apparently, the scanning equipment is different, and for this particular CT where she and the thoracic surgeon want a close look at the nodules in the lungs, they prefer that the CT be done on the same equipment.

                So, I guess if you are switching locations for CT scans, know that different equipment can possibly give different scan results (I guess).
                Heidi

                Husband - age 51
                10/20/10 - Primary mediastinal seminoma - 10 x 9.3 cm; -HCG = 33 (<2.6); AFP = 3.5 (<9); LDH = 274 (100-200 )
                11/1/10 4X BEP
                12/7/10 End Cycle 2 - -HCG = 2; AFP = 4.6; LDH = 139 ; 4XBEP changed to 3 as tumor now 2.1 x 3.7 cm
                2/15/11 - Post-chemo PET ; residual 8 mm x 2 cm
                6/29/11 - Lung nodules stable or smaller, chest mass continues to shrink & markers all normal
                Surveillance since 6/11

                Comment


                • #9
                  Originally posted by hbr777 View Post
                  So, I guess if you are switching locations for CT scans, know that different equipment can possibly give different scan results (I guess).
                  That is true - newer machines probably give higher resolution. Moreover, protocols seem to vary (especially with respect to contrast), as does one factor you already touched on - the expertise of the doctors reading the scans.

                  Comment


                  • #10
                    Just what we don't need: more ambiguity with the scans. They are already a mess as they can't really compare the before chemo scans as the lung as deflated due to the mediastinal mass, to the after scans when the lung reinflated. The last thing we want to do is throw a different CT scanner etc.. into the mix.
                    Heidi

                    Husband - age 51
                    10/20/10 - Primary mediastinal seminoma - 10 x 9.3 cm; -HCG = 33 (<2.6); AFP = 3.5 (<9); LDH = 274 (100-200 )
                    11/1/10 4X BEP
                    12/7/10 End Cycle 2 - -HCG = 2; AFP = 4.6; LDH = 139 ; 4XBEP changed to 3 as tumor now 2.1 x 3.7 cm
                    2/15/11 - Post-chemo PET ; residual 8 mm x 2 cm
                    6/29/11 - Lung nodules stable or smaller, chest mass continues to shrink & markers all normal
                    Surveillance since 6/11

                    Comment


                    • #11
                      I guess all policies are indeed different. I went line by line of my coverage when I was diagnosed and found a clause that said all imaging or lab work done as a "physician office visit" (non-specialist) was covered 100% after a $20 co-pay.

                      My GP's office has full imaging in house so I have all of my follow ups done there and since the GP and the Onco are part of the same system they have access to all of the info on the computer. My Ct's, Xrays and lab work are all covered in the $20 co-pay.

                      If I were to do the CT's and cxr's at the onco office it would technically be an outpatient visit at a hospital as that is where the imaging is and subject to 20% of the contracted rate.

                      I have spoken with numerous people here that have found that clause as well after they searched a bit. It depends on whether your GP has the services at their office.

                      Anyway, I hope this helps??
                      6-25-10 - Dx AFP 38
                      6-28-10 - Right I/O
                      Path: 3.5x3.4x2.9cm: 50% EC with, yolk sack elements and teratoma, seminoma (5%). No invasion.
                      7-13-10 - AFP 18.5, HCG Normal
                      7- -21-10 - AFP 5.3, HCG Normal
                      7-27-10 - surveillance
                      8-9-10 Path from IU: 10% EC, 65% mature teratoma, 5% seminoma and yolk sac
                      10-15-10 Enlarged lymph node
                      11/4 Hcg 3
                      11/10-11/19 rplnd at IU with 6 day ileus
                      11/19/12- 2 year post rplnd ALL CLEAR!

                      Comment

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