medicare payments

[claire1]

Hi All

I really need to know how much,ballpark figure, does the gamma knife or cyber knife cost before insurance payments.  I'm on disability for a serious back injury and am on medicare.  They would be paying 80 % but I'm worried about the other 20 %. How much does it cost for the raduiation?
Please if anyone recieved an itemized billing I would appreciate the info on the bottom line.  You don''t get rich on disability.
Thank You in Advance

[ppearl214]

Hey Claire!

I hope you are doing ok... been thinking about you!

I'm only going to respond re: CK as that was most of my research when it came down to investigating for my health insurance benefits.  Before insurance, I have heard anywhere between $50,000 to $80,000.  I believe it is based on each individual location/treatment facility.

Suggestion.... call the billing office at the treating facility (regardless if GK, CK, etc)... tell them you are investigating "sterotactic radiation" at their site (and note which technology... ie: GK or CK or whatever) and that you are an Acoustic Neuroma patient (so that way, they know the diagnosis).... and ask them outright.  Since they do the billing, they should know approx costs....  the sect'y in the treatment facility for the treating physician can also assist with getting the answer for you.

hoping others can help answer as well.
Phyl

[Mark]

Claire,

I think it would be best to contact the center you're considering being treated at to get an accurate cost projection. Also, many medical centers will review the insurance coverage and give you an accurate figure of what wouldn't be covered and on occasion make adjustments based on ability to pay factors.

In my case , I think the total "bill" for 3 CK treatments including CT scans etc was somewhere in the $60-70K range but that was also almost 7 years ago, so someone who has been treated more recently will probably have a better number


Mark

[mema]

Claire,

I had fsr 26 treatments.  I remember thinking when I saw the bills it was less than I expected.  I think about $35,000.  I would contact a facility and try and get an estimate cost.  Good luck

mema

[Jim Scott]

Claire:

To the beast of my knowledge, Gamma Knife, CyberKnife and FSR treatments all run well over $25,000.  That's a 'ballpark' figure.  Obviously, contacting the treating facility will get you a more precise figure that is relevant to your particular case.  I know that different areas of the country often have varying prices, although the equipment costs in the millions, so it won't ever be 'cheap'.  Since you're going to be liable for 20% of the total, you could be looking at a bill for well over $5,000.  Find out what kind of long-term payment plan the facility offers and also look into any possible government aid or even charitable organizations that might be able to help you with that kind of bill.  Occasionally, a hospital facility has in-house endowments that are designated for patients who are in dire need of treatment, have insurance and/or income but can't afford to pay for the procedure in full, without incurring long-term debt.  Ask about this, if it comes to that.  There is always a way, but you have to search for it.   It's time and effort well spent if it allows you to get the treatment you need at a price you can actually afford.

I wish you all the best as you seek a solution to your dilemma.   Let us know how this works out. 

Jim

[claire1]

Hi Jim
Thank you so much for all the information.  I'll stick it in my list of questions for the cyberknife people when I see them on Wed. next week.
Have a Great Day
Claire

[goinbatty]

Sorry to be responding to this so late.  I haven't been on here in awhile.  It's been a few years since I worked with Medicare issues but they reimburse according to DRGs (diagnosis related groups). 
http://en.wikipedia.org/wiki/Diagnosis-related_group
For anyone who has loads of time to kill reading and wants to be even more confused:
http://oig.hhs.gov/oei/reports/oei-09-00-00200.pdf

As for my CK, x5 was around $75,000.  My commercial insurance reimbursed at their PPO rate of around $48,000.  Thank goodness, I didn't have to pay anything. 

[lacey7]

Clare,
I also have medicare.  I'm on social security disability for fibromyalgia.  Along with my medicare, I also got a plan for Section D.  I got medicare plus blue - thru blue cross/blue shield.
I had 2 surgeries for AN.  One was to take out the AN, then after being home for 3 days, I developed a spinal cord leak, out of my nose.  Had to go right back into the hospital, and they operated on me the next morning.  My hubby figured out the entire bill that we got so far, and the total was $140,000.  I did not have to pay a penny of this.  Everyone accepted whatever medicare paid.  And also remember, I had 2 surgeries and over a week in intensive care.  Know what medicare ended up paying them of that bill?  $38,000.   I had a translab surgery.
I'm not sure of this, but I think if you get some kind of coverage to go along with medicare, then you won't have to pay the 20 percent.  Isn't it ridiculous what everyone accepts with medicare, but if I did't have any kind of insurance, they would have made me pay the full amount.   
Good luck, and I'm glad you at least have medicare.  I think it's great.  Sometime maybe you can check into getting an additional supplimental insurance.
God Bless,
Lacey

[goinbatty]

From what I understand about secondary coverage to Medicare, it helps with deductibles, copays and prescription drugs.  But talk about confusing.  There are way too many types of plans to pick from. 
For anyone out there with no or poor coverage, always remember that you can negotiate or at least attempt to. 
Also remember if you are utilizing PPO providers, they can't bill you for the difference between the allowed amount and total charge.  You would only be responsible for deductibles/copays.