cost of Radiation

[Pmann]

My coworker/boss has pelvic bone hot spots and his MO wanted to have them irradiated with five doses but insurance refuses to pay. He was asking me what those five doses would cost out of pocket. I don’t have a clue and thought I would ask the group.

[fireandice123]

I would just ask the hospital what the cost would be for a patient to pay, as opposed to what the insurance would pay. The hospital should have no problem doing that. They’ll most likely charge an individual less than they charge an insurance company.

Did he appeal the insurance rejection? That would be my first step. I was in a similar situation. Insurance refused to pay for radiation and I appealed it. Ultimately they paid.

[Pmann in reply to fireandice123]

Thanks and yes he is waiting on the appeal response.

[fireandice123 in reply to Pmann]

I should have mentioned that while I was waiting on the appeal I asked the hospital what the cost would be if I paid. I believe it was around $20k but that’s probably not terribly accurate for this situation as I had 20 sessions of RT.

[Tall_Allen in reply to fireandice123]

Hospitals charge individuals much more, not less. Insurance companies get negotiated lower rates.

[fireandice123 in reply to Tall_Allen]

That’s interesting. That makes sense-but the quote they gave me for me paying for my RT was considerably less than what the insurance ended up paying. Wonder why?

[Grandpa4 in reply to fireandice123]

I can not speak to hospitals but for most of medicine we charge the insurance company more then give private pay patients a lower rate.

[dhccpa in reply to fireandice123]

I thought just the opposite. Without insurance rates, the charge is more normally, isn't it? Admittedly, the charge can be negotiated, but insurance companies negotiate volume discounts. Still, in our crazy system, anything is possible.

[tango65]

It is very variable, but usually pretty expensive, particular for an individual (non negotiated prices). SBRT may cost around $ 20,000 per treatment session.

He could negotiate the price of the whole treatment (hospital and professional fees) before the treatment.

These negotiations are possible with some hospitals and doctors since private patients may end up paying more than Medicare or other insurance companies.

[cesces]

1. Once it becomes metastatic, spot treatment doesn't help. Not worth it unless the tumor is impinging a nerve or something.

2. The are online services that will give the wholesale price for most procedures.

3. Use sbrt instead of imrt.

4. A small clinic may be willing to negotiate price. A big hospital not so much.

5. Get a competitive quote from an indian or thai hospital that caters to healthcare tourists.

6. But first get some second opinions from medical oncologists mentioned in these forums. The insurance company is probably right. Radiation at this point is probably wasted sword motion. You need some type of global treatment.

7. Even if you decide to spot treat, it should be done in conjunction with some form of global treatment.

8. Is he getting some form of global treatment now?

[20PeteG16]

I had 10 radiation treatments in August on hip and pelvis. Waiting for statements from Medicare and Tricare...

However the level of pain went from constant 8 to 1 on some days. I'll pay!

PeteG

[Kenn2017]

I am a Mayo patient. I have had spot treatments but according to my radiation oncologist, he recommends not treating every spot unless it is a problem. He stated that doing so destroys bone marrow cells and would cause my immune system to decline.

[Seasid in reply to Kenn2017]

i agree. I am just thinking to radiate my neck only under my skull in order to minimize the spread of the cancer to my brain and skull

[Seasid in reply to Kenn2017]

how many spot treatments did you have and how did you decide what to radiate? Did you use SBRT?

[cancerfox]

My IMRT treatments (25) were billed at $932 each for radiation to my prostate, and my insurance and I actually paid $424 for each treatment. Wasn't at a hospital, though, but at a urology center, so it was probably cheaper than a hospital.

[cancerfox]

No. The preliminary CRT, leg mold creation, markers insertion, etc. were separate charges. The $932 was only for the radiation sessions themselves, which generally took from about 30 to 60 minutes, depending on how well things went.

[cancerfox]

Sounds about right for the setup cost. I had to pay 20% of everything, but that beats paying 100%. I think they are making money on us, though. 😃