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Thread: Bladder Botox = 3 colonoscopies

  1. #1
    Senior Member
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    Bladder Botox = 3 colonoscopies

    One round of bladder Botox goes at $16,600 compared to $5,500 for a colonoscopy.
    Is that because the probe has to be smaller? ;-P
    T3 complete since Sept 2015.

  2. #2
    Not sure where you're getting your numbers, but if they're for the US (presumably, because the numbers are orders of magnitude larger than they are elsewhere in the world) you can't be right.

    I assume you're basing this off of some EOBs that you got in the mail and I'm not calling you a liar, you just can't be right. Obviously you might know what the hospital billed your insurance company (which is a made up pie in the sky number that doesn't mean anything) and you might even know what your insurance company paid (which I guess actually means something, but only to those specific procedures between your specific hospital and your specific insurer), but there isn't a single person in the world who can tell you what medical procedures cost in the US because it's all a big secret.

    The hospital bills at 400% to 1000% (sometimes more) of what they think the highest reimbursement they might get from an insurance company is. So if they know they can negotiate a rate for $100 for "Procedure X" from BCBS which is their most lavish, spendthrift insurance company, they will charge $500 or so. This means all insurance companies (or patients if they have no insurance) get a bill from the hospital for $500 for each Procedure X. But that $500 is made up, very few (and only uniformed) people will pay $500. The hospital negotiates individually with each insurance company to set a rate of what they will pay for each procedure (sometimes this is simplified and an insurance company might agree to pay 120% of the medicare reimbursement rate for example, but they have the power to negotiate for every single different procedure, visit, test, etc). So it ends up something like this (all for the same procedure).

    Medicaid - billed $500, pays hospital agreed upon rate of $32.46
    Medicare - billed $500, pays hospital agreed upon rate of $42
    Cigna - billed $500, pays hospital agreed upon rate of $65
    BCBS - billed $500, pays hospital agreed upon rate of $100

    So why the hell do they bill for $500 anyway? Because if they charged $98 for the procedure they would be missing that extra two dollars from BCBS, so they set the bill MUCH higher than the highest they think they might possibly be able to negotiate with someone.

    But what if you have no insurance? That's a mixed bag too.

    Patient 1 - No insurance, dead broke, not disabled so no Medicaid (in my lovely southern state at least), billed $500, never opens the bill because they got evicted from their apartment after losing their job while in the hospital for procedure X. Pays $0.
    Patient 2 - No insurance, self employed, but knowledgeable about how this dastardly business works. Billed $500, calls billing department of hospital and says "this is some bull, how about I give you $120 instead?" hospital says "yes thank you!" and banks one of the highest profits they will ever get for procedure X.
    Patient 3 - No insurance, has some money, but doesn't know how the system works. Billed $500, pays $500 and goes without food for three months... they're the suckers, and the hospital just made a 1200% profit on their ignorance of the system, and happily laughs their way to the bank.
    Patient 4 - No insurance, a little money, but can't pay and doesn't know how the system works. Billed $500, calls hospital and says they can't pay. Hospital says (depending on how blood sucking they are) "that's fine we'll put you on a payment plan, please pay $100 a month for the next five months". Patient struggles to pay $100 a month for three months, but loses job and can't pay any longer. The hospital I work at (formerly a public hospital and presumably still a not for profit academic hospital) says "Oh, Mr. Patient 4, that's terrible news, but I'm afraid I am going to have to put a lean against your house until we recover the last $200 you owe us." This for a procedure they've already collected an 800% profit on and got paid three times more than their most generous insurers paid.

    But wait, there's more!

    This is just one hospital. Every... single... hospital or healthcare system negotiates rates every year with every other insurance company.

    So that pay scheduled for procedure X that ranged from $32 to $100 at your hospital might be $16 to $127 across town or $45 to $150 a half hour drive away.

    But no one will ever tell you this, because it's all a big secret, that's how they keep the profits so high. Even the doctor who is actually performing procedure X cannot find out how much his hospital bills for it, so if a patient asks him how much it will cost for him to do procedure X, the only honest answer is "I don't know".

    So as you can see, the colonoscopy that you might have been billed for $5,500, might have actually "cost" less than $1000 to your insurance company. It might well have been billed at $500 across town or $25,000 at a bigger hospital down the road. No one is to say that Botox might not be billed at $8,000 a pop at the hospital that charges $25,000, but all those numbers that are billed to insurance companies are made up anyway and don't mean a thing unless you're uninsured, rich and too foolish to try and negotiate a cheaper price.

  3. #3
    As funklab says above, it is all a scam.

    One consideration is the need for anesthesia for these procedures. Most colonoscopies are done with moderate sedation (IV) which does not require an anesthesiologist or certified nurse anesthetist to be present and administer. If you had either a spinal anesthetsia or general anesthesia for your Botox, that most likely included the fees for these additional providers.

    In addition, the Botox drug itself is not cheap, and the cost to the hospital or clinic for the drug will be significantly increased (common is 500%) over their actual cost. There is no drug used during a colonoscopy that would be similar.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  4. #4
    Quote Originally Posted by SCI-Nurse View Post
    As funklab says above, it is all a scam.

    One consideration is the need for anesthesia for these procedures. Most colonoscopies are done with moderate sedation (IV) which does not require an anesthesiologist or certified nurse anesthetist to be present and administer. If you had either a spinal anesthetsia or general anesthesia for your Botox, that most likely included the fees for these additional providers.

    In addition, the Botox drug itself is not cheap, and the cost to the hospital or clinic for the drug will be significantly increased (common is 500%) over their actual cost. There is no drug used during a colonoscopy that would be similar.

    (KLD)
    This is a good point. And while it probably won't affect your bottom line with regard to a copay, do you really need anesthesia?

    I've had botox at two different locations and a similar procedure with an equivalent amount of potential pain (for the neurologically normal patient) at a third hospital. Every time I told them I didn't want anesthesia (my injury is as complete as they get, I never feel anything). My urologist was up for it the first time, but the anesthesiologist insisted on being there (i think she was worried more than just looking to get paid, but I'm sure that factored into it as well), anesthesiologist tried to convince me to get some Versed just in case, but I said "woman, are you crazy? I gotta drive home!", and it was no big deal. Next time, same procedure at a different hospital I told the urologist I'd had it done before and I didn't need anesthesia, it took a small amount of convincing (by that time I had a bit of medical training so I could sound like I knew what I was talking about), but she agreed to do it in her office, not even bothering to take me to the surgical suite "just in case" no anesthesiologist involved at all. The third time I had a lot more medical training, but my urologist spoke about eight words to me in my one visit before the procedure because she mostly was just interested in signing off on whatever the NP told her, so she seemed surprised when I showed up in the operating suite fully conscious (though I'd told her I was going to refuse anesthesia), she did finally agree to do it, but only with the anesthetist right there beside us, "in case" again.

    Anyway, long boring story to say if you've got a complete injury you might not need anesthesia. I drove myself home from all four of my botox procedures, plus another urethral dilation that they wanted to knock me out for. Anesthesia is very safe and very unlikely to cause any complications, but personally I'd rather stay awake if there's no good reason to get knocked out.

  5. #5
    We recommend anesthesia for any cystoscopy procedure for those who are at risk for AD, as it is common during this procedure. Doesn't make a difference if you are complete or incomplete.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  6. #6
    All of my bladder Botox procedures were done without anesthesia. I am C6/7 complete. All of my bladder Botox procedures were done at UCSF (University of California San Francisco) by a l highly renowned neurourologist who was the father of a neurourology stimulators.

  7. #7
    Quote Originally Posted by SCI-Nurse View Post
    We recommend anesthesia for any cystoscopy procedure for those who are at risk for AD, as it is common during this procedure. Doesn't make a difference if you are complete or incomplete.

    (KLD)
    I forgot to mentiin my injury is low enough to not be at risk for AD. But thanks for keeping me from leading people astray.

  8. #8
    Quote Originally Posted by funklab View Post
    I forgot to mentiin my injury is low enough to not be at risk for AD. But thanks for keeping me from leading people astray.
    Your profile says T6. People with lesions at T7 or above are considered the risk group for AD; although it has been reported in those with lesions as low as T10.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  9. #9
    Quote Originally Posted by SCI-Nurse View Post
    Your profile says T6. People with lesions at T7 or above are considered the risk group for AD; although it has been reported in those with lesions as low as T10.

    (KLD)
    I probably need to update that, sensory it's more like T8 or T9 (the actual transection of the cord is at T11 where my fracture was). I've had broken toes, nightmarish burns, and multiple pressure sores on my feet and legs without any kind of AD symptoms (also I'm pretty sure I passed a kidney stone, which also didn't cause any AD) in addition to the above bladder procedures which didn't cause me any issues. Even injuries at T6 and above, only about half of SCIers have AD.

  10. #10
    Senior Member
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    Quote Originally Posted by SCI-Nurse View Post
    As funklab says above, it is all a scam.

    One consideration is the need for anesthesia for these procedures. Most colonoscopies are done with moderate sedation (IV) which does not require an anesthesiologist or certified nurse anesthetist to be present and administer. If you had either a spinal anesthetsia or general anesthesia for your Botox, that most likely included the fees for these additional providers.

    In addition, the Botox drug itself is not cheap, and the cost to the hospital or clinic for the drug will be significantly increased (common is 500%) over their actual cost. There is no drug used during a colonoscopy that would be similar.

    (KLD)
    First off - totally agree it's all a scam. Hell, my DME provider threw a price of $123k at my insurance for a Permobil F5 VS; my insurance paid about $25k

    Regarding the procedures, no, it wasn't the anesthesia.

    Both were mild sedation. The Botox was propofol and the colonoscopy was Demerol plus something I can't remember that I think started with a V.
    Either way propofol is often used for colonoscopies - my MD next door neighbor just had a colonoscopy with a side of propofol.
    T3 complete since Sept 2015.

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