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Thread: Outrageous Cost of Cystoscopy

  1. #1
    Senior Member dnvrdave's Avatar
    Join Date
    Feb 2002
    Denver, Colorado USA ---- C5/6 Complete 1985

    Outrageous Cost of Cystoscopy

    For a simple outpatient cystoscopy, I was just charged:

    1) $950 by Craig Hospital for "operating room procedure"
    2) $504 by The Urology Center for the "surgery" and doctor's fee

    These are "in network" providers, and my insurance approved:
    1) $740
    2) $250

    which burned up all my insurance for the year, and went over by $300, which they say I owe.

    I want to fight with Craig Hospital about the $740, even though it was approved by insurance, because it looks like it was just for the use of the room.

    Craig Hospital does these procedures all day long, Monday through Friday. I can't believe they get away with charging this much!

    What has been your experience with the cost of a routine cystoscopy?

    Do you think they made a mistake? They say they didn't.

  2. #2
    Senior Member
    Join Date
    Jun 2005
    East Bay in the San Francisco area
    Because we don't know anything about the kind of insurance you have and your deductibles and your co-pays, and what you have paid for other services in the year you had the cystoscopy etc., it is absolutely impossible to judge what is a fair charge to you. Insurance programs vary so much that these charges to you may be well within the norm for your coverage and be way out of the norm of charges for someone else with another type of insurance coverage. Is your coverage HMO, PPO...etc., etc., etc?

    Your comment about "burning up all your insurance for the year" really doesn't mean much and is not comparable to other programs....there are so many insurance programs and allowable charges that you can't compare one to the other unless you are comparing like insurance programs.

    All the best,

  3. #3
    HI, I recommend you contact the hospital and get all details, then speak with yor insurance company again for clarification or alowables and charges.

    If, in fact, this is true and your financial situation cannot pay this- you can solicit the hospital patient advocate or similar person and ask for some reduction in charges.

    You can also call around to other local hospitals to get comparable charge information. I agree that health care charges are confusing and astronomical. I don't know how people do it without insurance.


  4. #4
    Senior Member dnvrdave's Avatar
    Join Date
    Feb 2002
    Denver, Colorado USA ---- C5/6 Complete 1985
    Quote Originally Posted by gjnl View Post
    ...there are so many insurance programs and allowable charges that you can't compare one to the other unless you are comparing like insurance programs.
    My complaint is not about insurance. I actually like my insurance. It reimburses the first $1000, makes me pay the next $800, and then charges me 10% after that. I "burned up" the first $1000 (unless I can win this dispute), and was not expecting that. So I still have insurance. I apologize for the misleading comment.

    My complaint is about the charges from the health care provider.

    If we are ever going to fix the health care system in the U.S., and not socialize it, providers need to be required to disclose their costs to us up front (so that there is more honesty, better competition and we can shop around). And there shouldn't be "contracted amounts". It should be the same price to everyone. (My insurance seems to have a "good ol' boy" network with some providers, where they charge and pay up to 5 times as much as the price of some out-of-network providers. And they make it very hard for me to go out-of-network. So I do have an insurance complaint, but that is a different topic.)

    Probably many others here don't know the amount their provider charged for their last cystoscopy (because their insurance paid it transparently to them), but I was hoping to use our collective experience to determine a "reasonable and customary cost".

    Before getting a product or service, we are required to sign something, taking ultimate responsibility for payment of the charges. The provider should be required to tell us those charges before we sign.

    Could you imagine going to the store and not seeing prices? Or bartering for our health care? It's possible, but inefficient and encourages dishonesty.

    (Sorry if I'm opening up a topic already discussed here. I didn't search this forum first.)

  5. #5
    I had one it October. Mine did include a biopsy, but I had charges for the room, supplies and more doctors than I can count. (They didn't charge me for using their lift to transfer.) The whole tab would take me a weekend to figure out, but it was well over $3000 and my insurance reduced charges and eliminated some other charges and ended up with a bill about 80% less than the original charges. Your facility charge wasn't out of line with mine.

    "Blessed are the pessimists, for they hath made backups." Exasperated 20:12

  6. #6
    Ok, a Canadian rant here. I had a cystoscopy on Tuesday and it cost me $0. Not sure what the actual cost was because we don't get invoiced. Right now I have 3 a year (problem with bladder stones), total cost $0.

  7. #7
    Insurance is so complicated...

    What you were charged seems reasonable.

    Typically, when you stay in network, the billing charges are lower then out of network. This is because the insurance company has negotiated with the provider/doctor/hospital to accept a lower rate of reimbursement in exchange for the "privilege" of having you and the other people in your insurance plan, as patients.

    So I am a little surprised that you easily find doctors willing to accept lower payment who are out of network. I would actually be a bit wary of a doctor "underbilling" the typical price. How are they saving this $? But I guess that can happen. Can you give an example where a provider has received 5 times the amount because he was in network? I admit, I have never seen that and if it existed it would most likely be some sort of fraud and would report it.

    I like your idea that patients should know before having any test done, what the potential cost could be. The tricky thing is that no doctor ordering tests has any idea what you - the patient - will need to pay for it. Because there are literally thousands of insurance plans, with different negotiated rates, different co-pays/out of pockets etc... They only way to know is if you ask your doctor for the name of the procedures/billing codes, and then you could call your insurance and ask what the coverage is. But I have found that even when I do this, I don't always get the right answer..... Sometimes the billing office at your hospital/clinic will do this too, as they want to confirm they will get paid before doing the test. They often have better luck then I do at finding out the true reimbursement rate. I have found that when it is up to me to find out this information, it is very painful....

    Hospitals are very expensive to run, so yes the extra charge they tack on to your procedure always seems crazy, as it is often higher then the charge to the doctor! Think of that as the charge to clean the surgery suite, pay for the nurse/tech that helps your doctor, sterilizing the tools, buying replacement tools, the heat, the medical school, health insurance for the janitor, training the resident who might be standing there watching etc...... and pay for the free care that some patients receive who are unable to pay their bills. Often part of the doctor charge for the procedure is going towards these costs too. The doctor never receives the full "doctor fee".

    We are moving towards a system where different providers will charge/receive similar amounts for services. Now, larger health insurance companies are trying to negotiate their rates to the levels of Medicare reimbursement, if they have enough pull. This is generally the lowest rate that doctors/hospitals receive. You may be aware that this level of reimbursement is sometimes so low that docs/hospitals lose money on Medicare patients. Medicaid rates are often similar, sometimes lower so some clinics now refuse to see Medicaid patients because of this. This is going to create a problem long term.

    I see a stratification of care developing in the future.... similar to what is happening in some countries with socialized medicine. Where those on Medicare/Medicaid will be able to go to hospitals that accept Medicare, and private hospitals/clinics will exist for the wealthier patients willing to pay out of pocket for their care. Or the rare patients that still have excellent insurance with high rates of reimbursement.

    We will also lose more good people going into Medicine, as the training path for positions is so long and stressful, with incomes dropping and increased stress due to demands to see more patients in less time. People in the past who became doctors, are choosing other careers.

    The thing that bothers me the most these days is that my father can spend an hour at his rehab hospital where he gets examined by a nursing assistant, a SCI nurse, sometimes a resident doctor, and a senior doctor specialist in SCI and have problems of pain, neurogenic bowel/bladder, rehab, depression, osteoporosis, wound care discussed and optimized - and that "doctor" visit will only be reimbursed $60 from Medicare. They lost a lot of money on us..... And then my father can see his dermatologist - who knows nothing about SCI and wound care - and she can spend 5 minutes with him and write a script for some anti-fungal topicals. And she gets reimbursed $130. Think of how many patients each doctor can see in a typical day.

    I still am happy with Obamacare though! I did want a single payer system, but I'm still glad we got some of the changes....

  8. #8
    I went on line to check my charges. My insurance was billed $5200 before all the various doctors started sending bills. What we had done wasn't exactly comparable, but your charges are much better than mine. When I posted earlier, I had only remembered part of the charges.

    "Blessed are the pessimists, for they hath made backups." Exasperated 20:12

  9. #9
    I am a doc and I don't understand why they needed a OR to look at your bladder. Are you sure that is all they did? Did they sedate you?

  10. #10
    Quote Originally Posted by loreo View Post
    Ok, a Canadian rant here. I had a cystoscopy on Tuesday and it cost me $0. Not sure what the actual cost was because we don't get invoiced. Right now I have 3 a year (problem with bladder stones), total cost $0.
    Yeah, gotta say, it's hard to read these stories as a Canadian without getting angry. Cystoscopies for sci are an annual routine here, they have you in and out in a few minutes. The only charge is for parking. Like loreo, I have no idea what the actual cost is, but I'm sure it's a fraction of the inflated costs of involving for-profit insurers.

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