anyone here whose very 1st biopsy was MRI fusion biopsy?

[maley2711]

My Doc referred for fusion biopsy, but insurer denied> did an insurer cover your fusion biopsy after a high PSA? I'm appealing, looking for backup.

[westof]

Hmm... Yep, here is a paragraph from my 1st post:

"However, as time went on, that reassurance was short lived. My PSA started to double at an alarming rate, until it reached 28 the following year. After doing tons of research, I decided to opt for a MRI Fusion biopsy . My Insurance wouldn't cover it, however, I negotiated a “contracted rate” of $1400 (down from the standard rate of $2500) with AD RAD. Worth EVERY penny!".

My MSK RO said that he would have done the same thing,

Best

[maley2711 in reply to westof]

" I negotiated a “contracted rate” of $1400 (down from the standard rate of $2500) with AD RAD. " who sis AD RAD? was the $1400 the total....for biopsy plus pathology......and a separate bill for MRI? Thanks so much! Dale

[westof in reply to maley2711]

Yes Dale, I live in CT and have an excellent Anthem policy (my wife is a teacher).

I had to pay the hospital Doc a $300 co-pay.

AD RAD is Advanced Radiology. Went to them for the MRI ($1400).

My urologist would have done a standard (random) biopsy for free, however,

I had done my homework and decided to go with the MRI fusion biopsy.

My 2019 medical expenses exceeded 500k and my out of pocket was only a couple of thousand, excluding the biopsy. (meds and Dr's co-pays)

Read this, another reason I favor MRI fusion biopsy:

medpagetoday.com/special-re...

AJ

[maley2711 in reply to westof]

AJ - Thanks! so, to confirm........ for your very 1st biopsy, you decided on fusion, paid $1400 for MRI, and also $300 copay for fusion biopsy with pathology Gleason report?

[westof in reply to maley2711]

Yes, however, my Uro called me in to explain my Gleason results (he had nothing to do with the biopsy).

I was G9, T3 and no mets (after future scans).

[maley2711 in reply to westof]

Thanks so much westof......westof where? chuckle?

[Chemtrails-USA]

Yes to the question in your heading. October, 2018. Uro was rather pitiful in support department, I was <3 months from Medicare which DOES cover it, so I waited and abandoned appeal. MRI found a lesion, that lesion was targeted, and cancer was found there.

1 year later (last week), another MRI done for 2nd biopsy (I’m on AS, but groping around for best tx option), but no lesion found or anything else “suspicious for high-grade cancer”, so fusion biopsy canceled and standard biopsy done, waiting for results.

2nd biopsy varied rather wildly from first, e.g., showed prostate 60% smaller than 1st biopsy, which turned out to be B.S. So there’s that... (same machine, same radiologist).

I was quoted $3,400 for private pay MRI. Did not search around.

Good luck!

- Bobby

[maley2711 in reply to Chemtrails-USA]

Thanks Bobby! Just to confirm, youer VERY 1st MRI and the 1st FUSION biopsy(extra machine+software) covered by Medicare?? I thought not.....changed policy?I'm on wife's employer coverage now...could switch to Medicare at my 71!

[Chemtrails-USA in reply to maley2711]

Correct. Not sure if my supplemental plan picked up anything, don’t think much if anything, but everything together cost me $0. Will be same for this bx I just had. I’ve seen a top specialist in another state recently, ton of complex, genetic blood work (not prostate) which basically duplicated previous blood work, cost $0. I do have, I think, a deductible of $183/year. It’s great!

Good luck.

- Bobby

[maley2711 in reply to Chemtrails-USA]

Bobby - Thanks. My understanding supplements generally only cover anything which IS covered by Medicare A or B...though some add dental......eg Kaiser supplement. If Medicare now covers, my option is to go on Medicare B and forego wife's otherwise very good employer coverage. A BIG appeal point.....if Medicare now covers, why doesn't the employer coverage. I guess I can simply call the fusion biopsy person at local med school and they will definitely be able to confirm the Medicare coverage....I was referred there for my fusion biopsy!! Surely they have many old guy Medicare patients!!

Thanks a million !!! if standard of care per Medicare, should be for all insurers?

[Dachshundlove]

Fusion biopsy was 1st and only traditional biopsy in my husband’s case. Medicare covered it without a problem.

[maley2711]

Thank ou Dach !! I had just thought otherwise.....my bad memory ? Or maybe changed policy in last year? Have you found an easy way to check on specifics of Medicare coverage......assume it was Part B for fusion biopsy?

[Schwah]

I originally had a 14 needle random biopsy with nothing found. A few months later I did an mri guided biopsy. They said they only needed three needles since they saw the are of concern. All three were cancer Gleason 9. 0–14 on random biopsy vs 3-3 with mri guided biopsy. Hmmm. Seems like a no brained to me. Random biopsies should be a thing of the past.

Schwah

[ocman]

My MRI Fusion biopsy was denied and my urologist did a peer to peer review with anthem blue cross and they approved it.

[maley2711 in reply to ocman]

Thanks....congrats, but my urologist seems uninterested in doing this!!! Maybe because he is Kaiser Doc...and the insurer is also Kaiser.