My Medicare and BCBS SUPPLEMENT F pays for whole cost ever since FDA approved the scan. I paid about what you did for the UCLA trial GA 68 scan back in 2020
They didn't include the $8000.00 tracer? Thats the cost for Pylarify.
I'm waiting for the statements to come but that takes a while. This is what the hospital quoted me for cost. I questioned them a couple times on the cost and said I was expecting higher cost for the PET scan, but they said that's what my insurance BCBS negotiated for cost.I'll update this when I see what's on the actual bills and EOB.
If your insurance covers it, they will pay far lower than an uninsured individual will pay (or what you would pay for an unapproved scan, even with insurance). You probably know that already.
18 months ago, Kaiser paid, but sent me the billing for an uncovered person ...tracer plus PET scan approx $9k I believe. I had to argue to convince them to remove the $500 copay!!!!!!!!!!
I paid $3200 USD in May 2021 for a psma pet scan at UCLA In march 2023 I paid $3200 CDN at Initio lab in Vancouver BC I understand that the ga68 psma pet scan has been superceded by the pylirafy scan which costs $8000+ This scan is more readily available but a lot more expensive
So I had looking at my scan report the GA68 Gozetotide PSMA scan (Illucix) in NC. Told my cost based on contract price with BCBS (which was all paid by me on my deductible) was $3456It was very successful in finding PC in lymph nodes at 1.18 PSA
In the fall of 2022. BCBS required bone scan and CT scan before approving a PSMA scan. Also a 1.0 PSA and several other conditions as well. I was below 1.0 PSA I waited for 1.0 or greater now June 2023.
Dr at MAYO prescribed PSMA scan and MRI, BCBS approved MRI, denied PSMA required peer to peer which Dr doesn't do.
I immediately requested my other Dr at local hospital to prescribe PSMA, he does peer to peer and it was approved by BCBS.
I was expecting cost in the $20 k range but was surprised it was quoted to me at $3456.
I paid $3,300 out-of-pocket at UCLA in November 2021. My insurance wouldn't cover the cost at my PSA level (0.23 ng/mL). It had to be at 1.0 ng/mL for coverage to kick in.
I just received my bill from the hospital for the Plarify PSMA scan and once again blew my mind this time in the other direction.The cost billed to BCBS was if you can believe it $36,915.71
It shows I paid my deductible and that BCBS picked up the rest.
When I get the EOB from BCBS it may show the "discount" BCBS received, and the real cost of the scan.
Now this same scan is free for Canadians in Canada.
If I went to the private Canadian scan provider I wrote about earlier it would cost me $2415
This is what's wrong with American health care. $36,915.71 vs $2415 for a PSMA pet scan. Which by the way is about $600 to $800 in some other countries.
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