I was shocked when I saw how much medicare was charged for my PSMA Pet scan. The scan was done in the Boston area. There is no way the cost should be this high; let me know if I am missing something, thanks
Billed
$26,968.51
Insurance Covered
-$26,617.49
You Paid
$0.00
Your Balance
$351.02
At the only NCI local cancer center the cost is about the same (around $ 25 to 26 K). Private companies not associated with the cancer center charge around $ 5000 . In Germany at the University level , they charge around $ 4000.
Is there any disadvantage of having it done at a private facility for a fraction of the cost?
It depends on the equipment and the experiencia of the nuclear medicine doctors reading this type of studies. This is very difficult to find out.
IMHO the major findings will be similar in both institutions, I believe it won't make a difference. This has been my experience since I have had studies at the local NCI Cancer Center and at private clinic. No major differences.
If your cancer center has a digital PET scanner and or a digital PET/MRI machine, I would have the study done at the cancer center since these machines have a higher detection rate. If this is clinical significant or not, is beyond my knowledge.
I believe Medicare does not pay more than 5 to 6 K. They cover the cost of the tracer which is around 4K and then a reasonable fee for the machine use. I believe this is the reason that if you go to a private institution as self pay they will charge you around 6K, similar to what Medicare or other insurance will pay them.
Tango, thanks for the information. My medicare paid the whole amount and I was billed ~$350. I need to check whether my supplement plan picked up some of the cost
It wasn't divulged, on your end, but no way Medicare paid more than $5K
I look it up in detail.
Even when it seems Medicare paid the total amount of around $ 38,000 for a Pylarify PET/CT done las October, they really paid $ 7208.45 and I had to pay around $ 420 which 80% was covered by the medicare supplement.
I am not surprised the local NCI Cancer Center charged $ 38,000 for a Pylarify PET/CT, it is a very expensive place. They charge around 260K for a Pluvicto injection!!!
Kaiser billed me almost $25K and the patient responsibility was about $4,700.
Another friend paid cash at MD Anderson and his bill was $5K. Really no significant difference.
And then another social media support group from Down Under said their PSMA's are about $850 for the patient. My guess is that is probably close to cost as I recall some of the Universities running clinical trials and charging about that.
The most important factor is having staff who read the scans with great accuracy.
I don't think you are looking at the actual Medicare payment. There is something strange in the numbers your insurance company is giving you, maybe trying to make you think you are getting a great deal. As others said Medicare pays more like $5000 or so.
We really need to get rid of this for profit insurance racket paying executives and share holders more than doctors.
I have a medicare supplement plan, I was only billed $350
Our medical system is Capitalistic.It is, All about the Money.
Our medical system is a complete scam and rip off to the American people.
American people seem to be dumb.
The shell game of Advantage Plans.
I hate the lying. Hospitals, insurance and Big Pharma are dirty rotten, gready bastards.
I suppose a Communist system would be better?
America is ranked #36 in health care by the World Healthcare Organization.America is ranked #1 for health care cost.
America pays 10 times more than any other country for drugs.
Why do you bring up communism?
Your statement sounds like McCarthyism.
Best luck to you.
How about this: I was at Cedars-Sinai Medical Center (Los Angeles) for 10 days for a staph infection/sepsis and surgery to remove an abscess in my lower spine. Cedars billed Medicare — get ready — $582,243.58. That's $582,243.58. Medicare paid them $78,514.24. My deductible and any copays were covered by my supplement. Doctors walked into my room all week to check on me for 10 minutes — and billed Medicare $250 – $355 a pop and got a third of that. It's important to remember that we have a great system/health care racket in this country: If you have great insurance, you get in for the group-negotiated rates. If you walk in off the street with no insurance, you will pay the going rate and you can lose your home and life savings, unless they negotiate with you. A friend who had liver cancer (and eventually a transplant) first approached MD Anderson. I thought we had an easy in because a relative of mine left them a bunch of money and now has a cancer fund there named after her — BUT NO: Because he was a Kaiser patient, they wanted $25,000 for tests and an evaluation, discounted to $17,500 if he paid within a week. Seriously! He retired from the school district and switched to its PPO plan — and has paid practically nothing for any of his health care since. Good luck navigating all this!
I live In the UK. I paid £850 ($1080) for this procedure about a year ago. It is normally free but the waiting lists can be long so I paid for private treatment. Most Brits are astonished at the very high cost of healthcare in America. The upside is of course that you can access good treatment in a timely manner.
You are assuming everyone has the money to pay. Wrong.
Fair comment but this thread appears to point out the obvious short commings of a healthcare system which is funded through insurance cover. I hear many people who criticise a universal state funded health care model as exists in Britain. Within this model you can be financially destitute and you will still receive good treatment free of charge, the major drawback is the waiting times for non emergency treatment. We live in a free society so those who have sufficient money can choose to have private treatment and hence avoid delay. It is not perfect but for me I have always thought of it as being somewhat noble.
So tell me why a company doesn’t sell PSMA scans and that’s all they do? It’s a simple CT scan that could locate cancer early so you can deal with it. Seems like (assuming it actually works) that the cost would be down to a couple hundred bucks if you can do 100k a year of them around the country, I’m sure 100k scans is a way low number.
As you know, the USA system is vastly superior. That note was struck 250 years ago when General Washington told us the system of weights and measures we would adopt and permanently keep, even as the world around us changed.
A Timely manner is subjective. To see a specialist(in Surprise, Arizona) often has a 2-3 month appointment wait.
I would be happy to have your system or Canada's.
Could you share at what private clinic you got the treatment?
Bournemouth general hospital.
I have had two PSMA-PET scans in Louisville. The hospital billed Medicare $35,000 for the equipment and $9,000 for the technician for a total of $44,000. The Medicare plan allowance was $2,000 -- that is the amount that the hospital agreed the procedure is worth when they accept assignment of Medicare benefits. Of that, Medicare paid $1,800 and my Medicare supplement paid $200. I paid nothing.
Sounds correct. So why does hospital send a insane bill for $44k? Marketing. People in USA are dumb. Liying is accepted by many Americans.
It's just good business! I hate the BS.
Giant billings that really aren't that costly to Medicare. What's going on? Are they trying to make us feel guilty at the bills we are running up? I don't get it. What Medicare allows is the true cost. Why the bloated pretend cost? I sure am glad I reached Medicare age.
2 years ago the PSMA PET here in Portland at Kaiser was approx $13k billed, but our employee plan covered almost all. Will be interesting to see if my pSMA PET today is billed at much higher rate....I made sure it would be covered!!
I don't recall how much Medicare pays for the PET scans I've had. I've probably had 15 or 20. Bur I know they only pay a tiny fraction of what is billed, maybe 25-30 %. Fortunately my coinsurance pays the rest and I don't pay anything.
It's a crazy system. Medicare has a complex system by which they calculate how much they pay for things based on prevailing local charges and the providers history, so facilities and physicians have an incentive to keep raising their charges. Medicare may pay $6000 for a PET scan in Boston, $7000 in Miami or LA but only $4500 for a scan in Fargo, ND.
Now they have Big Pharma in their sights.
What should the price be in your opinion to be injected with a radioactive substance and be then put through a machine that can track that substance through your body, create images that a radiologist can read and interpret that provides a report of where tumors are located in your body?
Ed
Less.
Based on?
Moral imperative.
Every time I hear about the ridiculous cost of life-saving treatments, I think… waitaminute! You can cure these folks but only if they cough up a ridiculous amount of money, which will enrich your for-profit shareholders? Fuck you!
But, that’s just my take on it.
Isn't the actual PET scan machine the same as used for at least several earlier scans? The chemical is different? That's what the scan technician told me at my local center three weeks ago, when I asked about PSMA (I was having another Axumin).
Price is; Whatever the market will pay.The cost to produce a product/service often has little to do with market price.
It certainly sets the floor.
prior to fda approval I heard you could go to California and schedule one for 2500$. Many here will know for sure. It’s an insurance scam. Imagine how many less surgeries there would be if PSMA was the first thing that a man got instead of a blood test and a finger against a hidden gland.
Mine was $34,131.60 in Athens, Georgia. I figured between that, and the earlier biopsy, it cost around $69k just to get diagnosed.
Thank goodness for Obamacare (said unironically… if it wasn’t for my cheap-ass insurance this sort of thing would have financially crippled my family). I also wonder if I could have even gotten insurance after being diagnosed, if it wasn’t for the baby steps the US has taken towards universal healthcare.
lets hope that the baby steps are not reversed. about time we became adults.
I don't object to your praise of Obamacare, but mine at age 62-65 cost $22,000 per year (including my $6,000 deductible). I could see Medicare out on the horizon like a distant and hopeless mirage as the bleeding continued.
Our income is ridiculously low. Intentionally. So we may get more help with tax credits.
I hear you. My cancer was polite enough to manifest at age 66, past the Medicare 'money bubble' for those of you who, like me, play poker tournaments.
Here’s how I describe some of the costs of cancer diagnosis in my cancer comic (a work in progress).
Ha Ha really funny Just wait to see what they want next. My chemo was about $250,000 and pluvicto will be equal or more. Am I worth it, I do have a few close friends and relos who think so. At times I am not so sure.
Did you really create that comic? You've got skills, bro.
I started drawing comics late in life (around 45) and have regretted not consistently drawing my whole life after art school (did television graphics for 30 years). I’ve always joked that I’d get really good, and then die. I may get that wish. 😀
What did Medicare actually pay? That's the important number.
Prior to FDA approval I had three PSMA pet/ct scans at UCLA medical center for a fee of around $2,700 for each scan.
Since FDA approval cost of PSMA pet/ct scans are very high in the United States.
You can travel and save money to receive this scan if you are not on Medicare and your insurance doesn’t cover the scan.
I will travel to Vancouver where my doctor says it’s around $3,500 usd for the PSMA Pet/CT scan.
For younger men like myself not of Medicare age these scans are not covering by many insurance plans and drain your savings accounts. At some point blue cross and other commercial insurance will need to cover these scans.
This is an advanced prostate cancer group, stay focused if you're capable. No one cares about your politics, troublemaker.
All systems ( socialism, capitalism and communism) can work to better a society. There are poor, middle class and wealthy in all systems. Seems to me, the biggest difference is the level of greed the government officials exhibit running government.
I feel the greed in Washington DC. is at it's pinnacle. Lying is now, good business.
I hope " democracy" works, or we may have a king. Could be a good or bad King.
Get well my comrade.
😁🤣😂😆😂
I'm not getting the comrade moniker but that's okay. I assumed you may have given this issue a little thought. My assumption was incorrect.
Enjoy your day.
I have commented on this before. I was one of the first men in Florida to receive a PSMA PET scan At the UCLA center in LA California. This was January 2021 and it had just been approved the December prior. It was so new that the insurance companies had no code for it so I was told there was no way to even apply for a payment. After the scan I was prepared to pay what UCLA wanted by CC which was $2650. When I went to go pay, the lady looked up and said; “oh your insurance company has taken of this.” So I did an about face and walked out.
…about a month later I got the explanation of benefits. The UCLA center had received 10 times that amount of money I was going to be charged, being paid slightly over $26,000 for the same scan. I would’ve been happy to have paid them $2650. They were even happier that I did not.
…the above scenario is replayed in every treatment that I get. My providers bill $1000 and Medicare for example will only authorize $400 and they’re happy with that. This can only mean one of two things. Either they are going bankrupt or what their billing is many times more than what they actually need for the service. I don’t know how else to explain it. There’s no way that these hospitals and doctors and clinics can continue billing an amount three or four times higher than what Medicare is covering and still stay open. And if anyone can explain this, please try.
…in the end I guess we’re just happy to get the coverage but this system sooner or later will blow up and it can’t continue like this. Somethings got to give. Hopefully we won’t give out before the System does. Good luck. Rick.
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