• Do you know what you're charged for your cancer care, including what insurance picks up?

    Asked by FreeBird on Monday, September 3, 2012

    Do you know what you're charged for your cancer care, including what insurance picks up?

    Here are just a few of the costs from here in Florida:
    1 Oncologist office visit: $250 3-4 times a month, just the doctor without the lab
    Oncologist first hospital visit: $320
    Subsequent hospital visits: $250/ea.
    1 Chemo day: $5,000. chemotherapy drug Gemzar: $3,550. for a 30 minute infusion.
    (x3 times a month)

    It is something else, isnt' it?

    10 Answers from the Community

    10 answers
    • nancyjac's Avatar

      It's all a numbers game. There is the charge, the amount the insurance pays and the amount that is then written off. There just isn't much correlation between cost, price, and payment.

      about 4 years ago
    • GregP_WN's Avatar

      I was in the insurance industry several years ago, back then they called it "cost shifting". A person with insurance would be charged different rates for the same thing than someone with out insurance. Today it's similar but all different scales, rates depending on who pays, cash, ins. etc. Makes me sick. I wanted a bottle of chloraseptic spray to help numb my throat so I could eat when in hospital last time. They brought me a bottle of generic spray. I was billed 52.50 for it.
      and 25,000 for an overnight outpatient stay for surgery.

      about 4 years ago
    • Mollie's Avatar

      Wow. That's horrifying. I'm just so grateful my grandma has insurance. Thank you for sharing.

      about 4 years ago
    • nobrand's Avatar

      The bills are pretty confounding here.. One chemo session bill comes in about three pages, one of the charges is over $13,500 for "Immun/Inject." In fact, I can't tell what each charge is for at all. Add in the fact that my insurance company owns the hospital, so is charging itself these exorbitant prices and paying itself less / writing off the difference. I feel these EOBs sometimes feel like a glimpse into an intricate money laundering scheme.

      about 4 years ago
    • blondie's Avatar

      Maybe the doctor and your insurance agent can put together a list of drugs, price per drug, insurance payment, insurance adjustment, co-payment, and out-of-pocket expense.

      about 4 years ago
    • attypatty's Avatar

      Dear FreeBird:
      The chemotherapy drugs are expensive and the radiation machines cost a lot of money (million$$$$ - one source quoted Varian's new "low-cost" machine priced at $2 miilion). So the cost of an individual's treatment is amortized over the hospital's enormous cost of acquiring the drugs and machines. The real question is: "What is my health/survival/life worth? So far mine has been worth about:
      Chemotherapy: $75000; radiation: $7800; breast and axillary surgeries: $10000; port surgeries (put in/take out): $5200; testing - CT scan, MUGA (heart) scan (2), bone scan; chest xray): $12000; Blood transfusions: $8000; blood tests: $4000; AI drugs for 5 years: $14,000; doctor visits: $5,000. That's about $141,000 in all and I am estimating and probably forgetting a few things. Would I mortgage my house to pay $141K to live another 5 years? You bet I would because life is good. Luckily, I had great insurance and I was out of pocket less than $1000.
      Dulcinea is right about the Avastinn - it's one of the most expensive cancer treatments at $10K per round. It is worth it? I believe it is. I just don't know what someone would do if she or he didn't have good health insurance. I know that the drug companies offer treatment at low or no cost and hospitals can and do have foundations to cover cases of uninsured, but you have to qualify financially (i.e. have low income). I don't know that there is any way to reduce costs because the costs of research and development of these drugs and machines is high and takes a long time before they get to market. And the companies have a relatively short time to recoup all their costs before the drug goes generic, the patent expires, or the machine is outdated.
      I know I got on my soapbox a little too long, but I just think the advances in cancer treatment being made by the drug companies, like Genentech, Medivation, Immunogen, are amazing and will some day find cures to some cancers. Maybe the companies and the scientists who are doing this crucial and innovative work aren't really the bad guys, after all. And maybe we should buy stock in the companies that are doing so much to save our lives.
      Fight On,

      about 4 years ago
    • BuckeyeShelby's Avatar

      In addition, insurance can be confusing. Copays, coninsurance, out of pocket maximums. Until I started working for a third party administrator tha pays medical insurance, I was clueless. I'm fortunate that I've hit my out of pocket max for the year, so I'm covered @ 100% for the rest of 2012.

      about 4 years ago
    • Beaner54's Avatar

      Cancer treatment is terribly expensive....
      I have heard people say that the government doesn't really want to find a cure because this disease is big $$$$$
      Might be some truth in that but I hate to think that way.

      about 4 years ago
    • abrub's Avatar

      I do know that what insurers are billed and what they actually pay differ greatly. Also, if you are going to an in-network provider, regardless of what the provider bills, you are only responsible for what the insurer allows. Your Explanation of Benefits (EOB) explains the payments.

      For example, for an in-network procedure (from a real example)

      Procedure/CPT Code Qty Billed Amt Allowed Amt
      Ambulatory Surgery 1 $5209.13 $2673.23

      Thus, although the hospital billed the insurance $5209.13; the insurer only allows $2673.23 for this procedure. If this is an in-network procedure, the hospital may not bill you for the difference! The total paid to the hospital, between your payments (your deductible and/or copay, and the balance paid by the insurer) will be $2673.23, and not a penny more. In an in-network situation, the provider cannot claim the difference.

      However, if this is an out-of-network provider, with the same numbers; your insurance total, including your insurance copayments and/or deductible will still total $2673.23. HOWEVER, in this case, you will be personally responsible for the difference between the Billed Amt and the Allowed Amt ($2535.90) in addition to your deductible/copay responsibilities.

      Thus the numbers you see billed to the insurance do not reflect what is actually paid for procedures in-network. For out-of-network, it is worth trying to negotiate with the business office to see if you can get a break on the total due.

      about 4 years ago
    • mgm48's Avatar

      Interesting - I was just looking into some of the costs as I approach Medicare next spring and one of the drugs I'm going to be taking is over $5,000 per month. The problem I see is that it is considered a prescription and I've yet to find a Part D Plan that covers it well. There's one that covers 60% for 6 months...then what ? The cynic in me is sure that the "big Pharma" folks don't want to find a cure just more expensive treatments.

      about 4 years ago

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