How much does GK or CK really cost?

[phantagrae]

I know that most of you who have had some sort of radiation treatment have had the benefit of some kind of insurance, so it might be hard to tell what the "real" numbers are.

I'm looking at trying to seek treatment without insurance coverage and it's very daunting and confusing.

I know that most states have some kind of program, especially if you are low-income or have no insurance, but I believe I may be over the income threshold, and technically I have insurance--just not the kind that's going to pay for anything.  I have no radiation treatment coverage.
But, if I use a state program, then I believe I would have to have my treatment done in my home state.  While there are GK facilities here, there is no CK in Arkansas, that I know of.
From what I've read, I think that CK might be my best hope for preserving my hearing, so that's what I was hoping for.

I'm a little confused about trying to talk to the folks at Barrow in AZ, because I ended up talking to someone at St Joseph's Hospital--but they are somehow connected...

Anyway, the self-pay numbers I was quoted were approximately $72,200.00 for GK and more like $85,000.00 for CK.  She said they'd ask for about 20% as a downpayment, and then do payments over a year.

I don't even know how to process that.  I know that at my local hospital, they gave me a self-pay discount for my MRI of about 70% off of the total, but I don't know if the numbers quoted above include a discount, or if those are just the raw numbers for what the procedure costs before insurance would normally apply.

Should I have had my primary care doc call in my referral instead of trying to figure this out myself?

I have friends and family who have said they're willing to help contribute toward my costs, but $90,000.00???

I want to get the best treatment I can, and I don't want to just go with the cheapest available option, but I don't know what to do.  I know that not everyone has the option of going out of state, and many people have successful treatment at their local hospital.
I was just hoping that I could work this out.  I just had no idea how expensive it all is.  And I don't even know that it would be all that much cheaper to have it done locally, anyway.

  

[arizonajack]

I'm a little confused about trying to talk to the folks at Barrow in AZ, because I ended up talking to someone at St Joseph's Hospital--but they are somehow connected...

That's because the Barrow Neurological Institute is a division of St Joseph's Hospital so the charges from St Joseph's will be for the facility, the equipment and whatever hospital staff members are involved. Doctors who are not on staff but have privileges and are involved in the procedure will bill separately.

Anyway, the self-pay numbers I was quoted were approximately $72,200.00 for GK and more like $85,000.00 for CK.  She said they'd ask for about 20% as a downpayment, and then do payments over a year.

I don't even know how to process that. 

Neither do I.

The VA paid for my GK but I was able to get a copy of the account statement that was used to generate the charges from St Joseph's:

ECG 343.00
MRI 2928.00
Contrast 160.00
Staff Radiation Oncologist 3991.00
Staff Physicist 3140.00
Gamma Knife 9710.00
Some Misc Charges 459.00

Total 20731.00

Neurosurgeon:
Initial Consult 400.00
Gamma Knife 3500.00
Head Frame 600.00

Total 4500.00

Neurotologist:
Initial Consult 469.00
Gamma Knife 2531.00
Post GK Office Visit 82.00

Total 3082.00

The VA, of course, paid a significantly reduced amount but I don't know if those gross charges are the same for self pay or different for contract pay.
 

I know that at my local hospital, they gave me a self-pay discount for my MRI of about 70% off of the total, but I don't know if the numbers quoted above include a discount, or if those are just the raw numbers for what the procedure costs before insurance would normally apply.

You might try asking for a written statement of costs and discounts. Good luck with that, though. I had a ***** of a time even getting basic information even after it was all done.

Should I have had my primary care doc call in my referral instead of trying to figure this out myself?

I don't know that it would have made any difference in finding out what it would cost. Doctors generally have no clue as to how much they, or anybody else, charges because they have billing services that take care of all that and all they care about is how much is in their paycheck and not where it comes from.

I don't think you will ever get a straight answer about the cost until you get the bills.

I once tried to scope that out for a colonoscopy several years and the final bills were about twice what everybody was telling me on the phone.

[rupert]

If I remember correctly, my GK procedure in 2010  was right around $80,000.   If you're not using insurance I think you can use the barter system and come to some agreement on the price.  Usually a lot lower.   This may require negotiating with the doctor and all parties involved seperately.

[Nannybee]

The charges submitted to my insurance company were around 85,000. Procedure was just done in April.

[mesafinn]

There is a large distinction between "insurance pay" and "self pay."  For example, when I heard from Stanford about CK, I was given an insurance amount and then an amount that was 40% less if I was paying out-of-pocket.

Each place I contacted had various rates depending on insurance coverage, co-pays, and no insurance.

CK will cost more than GK.

GK across the U.S. ranges in price (for completely out-of-pocket) between 20-50k.  If someone is quoted more than that, keep looking.  There are high-quality places who will do it for as little as $20,000.

[robinb]

Well, after going back and forth with my insurer we are 99.99% done with getting what they will pay.

There "really" is no straight answer to what any procedure "really" costs.

The real question is what does it "really" cost each individual out of pocket.

However, for those less fortunate that must pay all costs out of pocket, I would recommend trying to negotiate all expenses down to what the hospital and docs have agreed to accept as "allowable charges". 

This too will vary from insurer to insurer. I offer the following from my own personal experience with Dr. Lunsford's team at UPMC:


Doctor/Facility                               Total Charges   Allowable charges   Deductible      Copay   CoInsurance   other amounts not covered   Member Responsibility
UPMC PRESBYTERIAN SHADYSIDE (SD   $54,344.00    $23,787.38                  $800.00           $10.00    $1,187.70    $21.73                                    $2,019.43 
UNIVERSITY OF PITTSBURGH PHYSIC   $3,741.00    $1,047.00                  $0.00           $60.00    $0.00                   $0.00                                    $60.00 
UNIVERSITY RADIOLOGISTS             $868.00                   $236.71                                 $0.00           $0.00    $0.00                   $0.00                                    $0.00 
UNIVERSITY OF PITTSBURGH PHYSIC   $1,030.00    $304.00                                 $0.00           $0.00    $60.80                   $0.00                                    $60.80 
UNIVERSITY NEUROSURGICAL   $15,598.00    $4,181.25                  $0.00           $0.00    $0.00                   $0.00                                    $0.00 
UNIVERSITY NEUROSURGICAL   $203.00                   $107.00                                 $0.00           $60.00    $0.00                   $0.00                                    $60.00 
UPMC PRESBYTERIAN SHADYSIDE   $39.25                   $29.25                                $0.00           $10.00    $0.00                    $0.00                                    $10.00 
                     
        TOTAL                         $75,823.25    $29,692.59                 $800.00           $140.00    $1,248.50    $21.73                                $2,210.23




My point in making this available for all is to show that the hospital and docs billed a total of over 75k, but AGREED with my insurer that would accept just under 30k. So is this what it "really" costs? I don't know. 

At the end of the day, what each of us cares about is what it "really" costs us personally. In my case, I consider it very fortunate that my out of pocket is $2,210.83.

If anyone wants more details/info just send me a PM.

PS - sorry for the layout but I could not figure out how to upload an excel chart.

[phantagrae]

Thanks to all who responded, either her or in PMs.

I just talked to someone in Dr Shetter's office at Barrow and she essentially told me to call back when I had the $100,000+ (the number she quoted me) or when I had acquired major medical insurance.
Or to apply for local state aid and have my treatment done here.

 

Also, am I wrong to feel a sense of urgency about getting treatment?  I feel like I want to get it done--I was hoping for mid-July--because I want to try to put a stop to it before I have any real significant damage to my hearing.  So far I've been very fortunate, but I almost feel like I've got an invisible bomb in my head.  I can't see it to tell whether or not it's growing or whether it's doing damage to my auditory nerve.

My hearing seems to be unchanged for now, but my trigeminal nerve has been affected for probably a year now, with the symptoms more apparent in the last 6 months or so.

I don't want to rush into anything, but I don't want to wait until I start to lose my hearing (something this woman actually suggested...!  ) before I get treatment while I'm trying to scrape together some money (including money to pay for major medical out of my own pocket.)

 

[nftwoed]

Hello;

   Do the Drs. have a sense of urgency? One thing to remember about making a person wait to acquire that much money, or some guarantee of pmt, is that Barrow has the equipment already purchased, the Dr(s), techs, nurses on are already on staff and being paid anyhow. I'm unsure how that thinking strikes you.
   Beginning a hearing loss is no small matter and in this country, can be overcome at other facilities, I believe.
   If it were me, and there was indeed some urgency, I'd appeal to other Tx providers and definitely not the billing dept. first, but directly to the Dr.
   Re, your envisioning CK as superior; Maybe, or not. Each case is individual. Theoretically, maybe CK has a hearing sparing edge, but not overwhelmingly so. 

[mk]

Excuse my ignorance, but are these numbers for real?? 

My understanding from all the medical literature is that radiosurgery costs much less than conventional surgery. The numbers that I have heard about surgery say for example from HEI are about $100,000. How could GK or CK have a similar cost?

Also from what I know the cost for this surgery in some European countries, if you pay out of pocket is around the equivalent of $12,000-$20,000. The same is true for Canada (although we don't really see the amount, so I don't know an exact figure).
Assuming that the equipment/personnel/hospital stay etc are similar, how is a cost of $80,000-100,000 justified?

Sorry, but I am completely shocked.

Marianna



 

[terisandler]

Not sure, MK, but I had 5 CK sessions and those alone were about $85k with insurance discounts knocking it down to about $55k.  Then there were charges for doctors, radiologists, MRIs, CT scan and if I totaled it all I am pretty sure the total billed to insurance was $100k+.  Amazing! 

[phantagrae]

Excuse my ignorance, but are these numbers for real?? 

My understanding from all the medical literature is that radiosurgery costs much less than conventional surgery. The numbers that I have heard about surgery say for example from HEI are about $100,000. How could GK or CK have a similar cost?

Also from what I know the cost for this surgery in some European countries, if you pay out of pocket is around the equivalent of $12,000-$20,000. The same is true for Canada (although we don't really see the amount, so I don't know an exact figure).
Assuming that the equipment/personnel/hospital stay etc are similar, how is a cost of $80,000-100,000 justified?

Sorry, but I am completely shocked.

Marianna

Yeah, I think the $100,000 amount supposedly includes everything.

For me the hearing issue is paramount in that as a professional musician I want to choose the treatment that will have the least impact on my hearing.  From what I've read here and elsewhere, CK may indeed have only a slight edge over GK, but I don't want to gamble.

I hate to give up on the idea of CK, but I may end up going with my local hospital facility and the doctors with whom I spoke earlier.  The ENT I saw in April/May called me tonight to see what I was planning to do, to make sure I wasn't falling through the cracks.  He had heard from the neurosurgeon I saw that I was looking into going to Barrow, but he just wanted to check in with me.
He did offer to talk to the CARTI clinic here (where they would do the FSR if I have it done here) because of the financial assistance they have available.
While I really wanted to do CK, I may just end up going with FSR.
I had had just a disappointing day in talking with that person at Barrow and contemplating the idea of trying to raise $100,000.00.

I'm just trying to pray about what course to take.

[robinb]

Many times insurance will deny; have you contested the decision to higher levels; keep doing this until you have reached the top.

Although my insurance said I was covered for the procedure, they nitpicked some of the charges, about 8k worth, as not covered. After one round of disputes, they paid them.

Also, suggest you contact Dr. Chang at Stanford and Dr. Lunsford's office (for GK) to see if their facilities have better options for private pay.

[phantagrae]

Many times insurance will deny; have you contested the decision to higher levels; keep doing this until you have reached the top.

Although my insurance said I was covered for the procedure, they nitpicked some of the charges, about 8k worth, as not covered. After one round of disputes, they paid them.

Also, suggest you contact Dr. Chang at Stanford and Dr. Lunsford's office (for GK) to see if their facilities have better options for private pay.

I know my insurance won't pay for any of it because I don't have major medical and I have no coverage for radiation treatment, so there's really nothing to contest.
The main reason I was considering Barrow was that they have an AN team and are very experienced and also that they have CK, which seemed to me to be the best option for limiting damage to the cochlea (though maybe I'm kidding myself...)

If I'm treated here it will be FSR, also to limit damage to the cochlea as much as possible.

I got a call for an appointment with the doc at CARTI--he's a radiosurgeon, I believe, and I will see him on the 2nd to consult about my situation and I can talk to those people about what kind of costs I'm looking at, since I'll still probably have to do some fundraising.

[arizonajack]

Apropos of this conversation, the following article appeared in the July-August AARP Bulletin:

"Lifting the Veil on Hospital Rates"

Recently released government data showing what US hospitals charge for inpatient procedures may be ushering in a new era of transparency in health care costs, which have long been closely guarded by hospitals.

Health care advocates say Medicare's decision to publish the figures could lead to greater openness in other areas, such as patients' out-of-pocket costs, and eventually may result in a more comprehensible pricing structure medical expenses.

"It helps to begin the process of examining actual charges as opposed to just the payment amounts," says Keith Lind, a senior policy adviser at AARP.

The data from more than 3,300 US hospitals included the prices they charge - and the standard rate that Medicare pays - for thousands of treatments. The figures show a wild disparity in billing rates for the same procedures.

For example, a Houston hospital charged patients $126,157 for a hip replacement, while an Applegate, Wisconsin hospital charged $26,787. Medicare pays hospitals about $14,000 for that operation.

Stuart Guterman, vice president of the nonprofit Commonwealth Fund, says the data demonstrate that hospital charges have nothing to do with the cost or quality of care. "It's becoming less and less clear what hospital charges are based on," he says. The long-term goal "should be to make hospital charges relate to what the actual cost of care is."

[prisca]

I'm not sure that there ever could be one fair price for a procedure regardless of the hospital.  There are legitimate price differences in real estate and salaries (based on cost of living in an area).  It would have to cost more to have a hospital in San Francisco or NYC than in West Virginia or Oklahoma.