Finding out Costs?

QuinnCat

I never thought about doing mammograms in January so that if I discovered I had cancer I'd have the whole Health Insurance Calendar year to treat it. Sheez On the other hand, as I get this diagnosis, I find myself smack in the middle of Open Season for my Health Savings Account...giving me the opportunity to atleast put money away pre-tax for next year's cancer expenses. Atleast what I can afford ( not much), given out of pocket for all of my tests, surgery with immediate reconstruction may have wiped out my accessible savings ( and after just finishing a major house remodel). I was not prepared for the financial burden of cancer and I'm a bit ashamed about this.



Where can I find out costs ( typical allowable), surgery has not happened yet...for this year and next...only having bills for scans, biopsies, and a few doctor visits thus far? Also, last time I called the insurance company, they want codes.



Lumpectomy with breast reconstruction 2011

Radiation 2012

Possible Chemo 2012

Hormonal Therapy 2012

Followups 2012 to ....

QuinnCat

I'd like to add, my Catastrophic is $5000 each calendar year. My insurance pays all but $250 for hospital, 85% medical after copays, $350 calendar deductible. This may make the answer easier. It might mean I will owe $5000 a year, but maybe not? I just want to know how much on the minimum I should try to put in my HSA (if I can even do it) to help out on taxes.

Snobird

Kam, I slap have a high deductible with HSA account. Is $5000 your max out of pocket? Mine is 2600. Although in theory that should be your total out of pocket there may be other expenses that are not covered by insurance that you can use your HSA for. I put the max I can in every year for the deduct as well a financial cushion for other medical expenses such as eye and dental work that are not covered but you can use your HSA money for. I was diagnosed in late nov in 2006 when we had a $5000 deduct for a family plan. We have switched to the 2600 because with this DX comes a lot of expenses which are covered by insurance and I didn't want to have to pay 5000 every year. The premium is higher but still a better deal. It is currently open enrollment time so you may want to see if you can switch. My husband and I also switched to individual plans frm family and that has really helped. The premium was actually less money. I would check with you plans administrator to see what you can work out.

QuinnCat

Great suggestions snobird...while I have lot's of plans to choose from, most of them are catastrohpic $4000 to $5000 for Self Only plans.  If they're lower, then something else is higher.  I have the same plans Congress has - while good - not fantastic, despite what they say.  (Everyday they look better, by comparison, though.)

I'll probably stick with the $5000 catastrophic plan, but am deciding on how much to put away into a separate Health Savings Plan for 2012. 

 Will I meet a $5000 out-of-pocket for Radiation, for example??  How much is a course of IMRT Radiation 5 days a week for 6 weeks??  How much is chemotherapy??  This year is water under the bridge, can't change a thing and while putting off surgery until 2012 would be financiall ideal, I'd rather go broke than risk my life.

Snobird

You wii have no problem meeting 5000 for radiation mine was way over 350,000.00 billed to insurance. Of course BCBS didn't pay out that much but paid their negotiated rate. I only paid my deductible and out of pocket max. The more you can squeeze into the calendar year the better for you as the out of pocket max resets every January for most plans.

QuinnCat

$350,000??  Seriously?

 I just called the company that would do radiation in my town (I live in a small town). 

 I'm just going with what I know about scheduling...5 days a week for 6 weeks...or standard lumpectomy radiation treatments:

 3D is $20,000..allowable is $15,000 to $17,000

IMRT is $45,000...allowable is $25,000 to $30,000

 My personal liability  for IMRT would be $3250 to $4500, but the company would give me a 10% discount if I paid my portion up front.

Now, how do I figure out if I would be getting 3D or IMRT, since I don't even have a radiation oncologist???

Snobird

You definitely need a radiation oncologist as well as a regular oncologist. You shouldn't start any therapy with consulting a breast surgeon, oncologist and a radiation oncologist. I suggest you find a comprehensive Breast Care Center if you can. I also live in a small town and I had to travel 2 hrs to a Certified Breast Care Center. You can also contact your insurance company for recommendations for one. It is very important to have a team approach to treatment. So far all my treatments with the exception of PS have been in network for me. My PS was covered thru my out of network coverage.



I know you are worried about the money but I found that the Doctors staff who deal with these financial issues all the time can be a big help. It's important to treat the cancer. All costs are negotiable so you tell them what you can afford to pay. I think the 20% discount up front sounds like a ploy to be the first paid in case your insurance company doesn't agree with the charges. I negotiated monthly payments against my total out of pocket bill with the treating hospital and each Dr even though I was paying out of my HSA which had enough money to pay the bill. I didn't want to pay too much ahead because all throughout your treatment there will be adjustments.

QuinnCat

I have a comprehensive treatment clinc, but so far I've only seen the BS, PS and Geneticist. They are also nearly 400 miles away, so it's not like I could come back to see the Radiation Oncologist (they were all at a conference the day the Team looked at my scans and biopsy).   The BS told me I would have radiation, but didn't specify the type.  I guess I'm so tired of calling my Clinic with yet another question and right now we're mainly trying to schedule the surgery, coordinating BS with PS.

 You confirmed what I felt about the discount.  I thought, well I'm going to end up paying my catastrophic no matter what discount you give me now, so it sounds like the only person who wins is the company offering the discount and I see no advantage to that. I'd rather  see a lot of my health care deliverers get some of my HSA money rather than one company getting it all up front!!   Thank you.

 So I'm back to wondering what determines the difference between getting  IMRT versus the less expensive 3D?? Perhaps there is a radiation thread??

Snobird

im not sure what your reconstruction plan is but if you are definitely having radiation treatment the 3 PS I saw would not do recon until 6 months post radiation due to 50% + chance of complications. There are good threads on here about radiation and reconstruction options that you should check out.

DivineMrsM

We just got a bill for 33 radiation treatments and I believe the bill was $19,000. 

It seemed to me that the bill for chemo and I'm pretty sure the cost was $120,000.  It sort of surprises me the chemo costs so much more, but maybe because of the drugs?

Insurance paid for most of this after a $500 copay and out of pocket max of $2,000 I think.  I have health insurance thru the company where my husband works.  Naturally, the one year I have all this medical stuff going on, the company changes insurance companies in AUGUST.  We are still not sure if we'll have to pay another deductible & out of pocket max.  It is such a pain in the you-know-what.  And the previous insurance company is dragging its feet paying up some of the bills I have prior to August.  It's a mess.  At least we have insurance, but a hassle to deal with at times.

QuinnCat

I'd like to delay the Reconstruction, but for reasons I've only been able to research, the PS wants to do a breast reduction at the time of lumpectomy. We still need to discuss that because I definitely need to lose weight and don't want to have a breast reduction before that! (Seems like my breasts really take a hit with weight gain and loss, though the PS says that changes over time)



I'm sure her need to do it pre-radiation has to do with the size I am and just the factor of radiating large breasts and possibly doing surgery after radiation and would that even qualify as "reconstruction" at that point.? (The latter being my question.) Also, just waiting til the radiation affects are gone--if they ever totally disappear? These are still outstanding questions for the PS. I woukd prefer it be done later and ofcourse that it still qualify as Reconstruction.



I've looked for answers to these questions here and haven't found them yet.



If I wait for any surgery til the new year I will be better off insurance wise, but I can't base my possibly lifesaving surgery on that darn insurance. Sucks that I will probably just make my $5000 catastrophic, then before radiation and chemo start the clock resets to zero on January 1.



Seriously, $120,000 for chemo? In that case, maybe it doesn't matter which year I have surgery. Is that typical??

Wendyspet

Kam -- I was diagnosed April 15, 2011.  I didn't have rads because I had mastectomies, but did have 6 chemo treatments, and will have herceptin thru June '12.  

My insurance has been billed over $258,000 for all my treatments so far, but with their discounts, have paid a little over $80,000.  Most of the charges are from the oncologist, the drugs are expensive!

QuinnCat

I had no idea. And I've just been worrying about combining surgery and radiation in the same year. Ofcourse, I don't know if I'll need chemo, but I'm flabbergasted at that cost. Also, I may be way off on how much the lumpectomy and reduction will cost... I was thinking maybe $25,000, but I'm forgetting about other things, like post surgical pathology, oncotyping, etc.



Just hoping the hormonal therapy doesn't break me in the out years.



I did find out that I'm qualified for up to a $300 gas card from ACS because of my zip code (and having cancer). That will help because I'm going 400 miles away for surgery, and the closest chemo is 65 miles (not a doctor for that in my town at the moment). Luckily we have radiation types and the machinery.

Snobird

If you are having radiation the preferred sequence of events by most PS are surgery, then radiation and at least 6 months before doing any reconstruction. If you have your surgery in Dec then radiation in January you could have recon done after June and get a major portion of your expenses in one year. You could even schedule the 2 nd stage of recon for nov or dec and get most all of your expenses in one year. Then whatever is left for you to pay is negotiable and a reasonable payment schedule can be set up by the Docs and Hospitals to pay off any balance due. You do not have to pay it all off immediately. I would put as much as you can into your HSA and use that to make payments against you deductible and out of pocket. Might as well get the tax deduction too while your at it.

Daysie

I am in the UK and here we have the National Health Service and also a Private Health Insurance providers.  The National Health Service is provided free, only cost is to tax payers, i.e. those in employment fund those who have and those who are unemployed.  All the scans, appointments and surgery is free, the NHS have the latest equipment and some are University hospitals where there are standards of excellence.  I cannot imagine having the worry of having to pay for treatment on top of the trauma of going through BC.  The NHS have been wonderful, fantastic nurses and consultants, treatment has been second to none.

Daysie  (London, England)

QuinnCat

I totally agree Daysie. Here I have had the same insurance company for 32 years, barely used it and still cannot afford to get sick. I'm a fervent supporter for Single payer medical care. I always use the example of my mother and her two sisters. They all got breast cancer at age 52 ( yes, I'm being tested for BRCA and my cost is $501 for that, btw...but only because I HAVE cancer will the insurance even pay...I guess I'm the family sacrificial lamb). One aunt lived in USA, didn't have health insurance and just chose to not treat. My other aunt lived in Canada and paid $15 a month for her insurance and lived another 25 years with the Canadian single payer system.



Snobird...I think my PS is atypical.. A breast reduction. Do you know anyone who has had that later, and particularly after radiation?

DivineMrsM

I had no idea the cost of treatment, either.  It's astounding.

I had a lumpectomy.  No reconstruction.  The bill was about $7,000 for the surgery.  Still getting other bills for that proceedure like the anesthesiologist which I think was about $700.

The doctor started me off on Tamoxifen which cost me $12.98 at Walmart for a 30 day supply of the generic.  Now I got switched to Arimidex and it cost around $38 for a month's supply.  I do have a prescription card.  The cost of the Arimidex was $107 prior to the girl scanning the card.

Of course, the health insurance premiums are taken out of DH's paycheck weekly.  So in addition to the deductible and out of pocket max we're also paying around $4500 a year for the premiums.  That doesn't include the prescription card premium that we also pay, altho off the top of my head I don't remember what that is.  And there's also a premium we pay for dental and vision.

CLC

The charges to my ins co (not the rate they actually pay) since September 1...$49,000.  And this tidy little sum was for...1 mri, 1 brca test, 1 stereotactic biopsy, 1 umx without recon, including doctors visits and hospital stay.  NO radiation, no chemo, no infections, no complications at all.  (And this number does not include my prosthesis or physical therapy).  My copays have come to $400, roughly.  I am so grateful to have such good insurance.  However, it is beyond my comprehension why I get so lucky while millions are uninsured or underinsured.  And why does my insurance company get to pay so much less than those who are uninsured? UGH.  I am totally with Daysie and Kam.  We need a single payer system here in the US.

DivineMrsM

The PET scan I had cost about $10,000 but the hospital charges the insurance company only $2,000 per an agreement with them.  It does seem outrageous that the charges are so astronomical.

lauri

When I asked my BS whether the insurance company would complain about mastectomy after lumpectomy and second surgery to try to get clean margins, he just laughed and said "this is the CHEAP part of treatment."   (No reconstruction, so there was no PS to pay.  And I sent back the bill to the anaesthesiologist saying "you got what the insurance paid -- as contracted with the hospital.) 

Get everybody in agreement on the best surgery / reconstruction / radiation timetable for you.   Discuss the question of breast reduction before radiation with BS, PS, radiation onc, medical onc -- there may be differences of opinion on this. 

The question of chemo won't be answered until you see the medical oncologist with pathology report from the surgery (and maybe Oncotype), but I believe the cost (as billed to the insurance, not what they actually paid based on their contract rate) was about $35,000 per month -- and I had chemo for about 5 months.

Once done with that, however, hormonal treatment can be cheap (in comparison) -- I get generic arimidex at Costco for about $55 for 90 days. 

Fearless_One

Call your hospitals "corporate pricing" department and tell them what insurance you have and ask them what the contract rate is for whatever procedure you want to inquire about.

QuinnCat

Everyone has given me great ideas.  I bumped up my Health Savings account amount to cover the Catostrophic.  It's open season for Feds right now.  They do have one insurance plan that has a $3000 catostrophic, decent benefits, but higher premiums.  It's almost a wash, premium versus catastrophic savings, but not quite.  Not sure how widespread they are. 

 I do know that "allowables" are different by insurance company, but if one is going to mee ttheir catastrophic no matter what, I guess that doesn't really matter. 

Question about Chemo - can it be generic??  I can't imagine it can be gotten from the Insurance Company (like the 90 day mail order supply). 

Chickadee

Are you certain that chemo will be the protocol? Being hormone positive you may be on an AI protocol first and there are several that will be tried before chemo. I'm 2+ years out and still haven't done chemo. I understand there are numerous chemo protocols as well so it might be hard to pin down costs when the treatment is so fluid.



Good luck pinning down these costs, it's a daunting task for sure.

11BC

When dealing w/ an out-of-network surgeon/oncologist/med care provider, have any of you been able to pin down costs/charges/insurance coverage before slating appts/surgeries/follow ups? Do any of you feel like you're "bartering" for your care w/ out-of-network providers?

I agree w/ Chickadee: It's important to pin down costs.

I had a BMX w/ reconstruction (silicone implants) in 2007 w/ an in-network plastic surgeon and oncology surgeon. Now I have capsular contracture in my irradiated/cancer-side breast and am seeking further reconstruction. I'm considering seeing an out-of-network plastic surgeon who specializes in the procedure I'm interested in doing. But the pricing seems vague. It seems to be based more on what I can pay and what my insurance can pay than on actual figures.

If I don't know the actual costs/charges up front, then how can I determine what my insurance will pay? Or what is a "fair" amount for me to pay? As I said, it seems as if I am bartering for services. Has anyone else come across this? 

I wish the best to all of you. Hang in there.