I’m going to START with three clarifications, because sometimes people don’t read footnotes. :-) Read before proceeding.
- I’m NOT saying there’s anything wrong here – don’t anyone assume that every time I blog, it’s a warpath. :) I’m just asking a question. My guiding principle on medical treatments and costs is that people should know what their options are, so I’m presenting my situation and asking.
- I’m also NOT asking for treatment advice – I’m only asking about costs and whether it sometimes makes sense to get pathology done elsewhere. (We’ve already discussed treatments and I’m satisfied.)
- As I’ve said before, I’m NOT recommending that anyone else act as I choose to.
Also, regular readers know that as a former cancer patient in New Hampshire, my insurance options were limited, and I chose $10,000 deductible, so all of this will come out of my pocket. As I’ve blogged many times before, this turns out to be a nifty way to discover how the money actually flows in American healthcare, which is usually really hard to find out.
Below is the pathology report from some biopsies I got in January. The bill is $416 list price; after the usual insurance discount, my balance due is $312.
- Does this $416 / $312 sound sensible for this? (I’m not complaining; just asking. I like and value good doctors.)
- If I decided to ask to have samples sent to another pathologist (also or instead), what issues would I run into?
The report I received
Two spots were tested, named here A (on my left shoulder) and B (near the spine (“paraspinal”), halfway down (“mid thoracic”)).
Glossary, as I understand things, open to correction as always:
- “R/O” means “rule out,” which basically means “check for…”
- BCC is basal cell carcinoma (same kind of skin cancer I had last time – hardly ever fatal)
- SBCC is superficial basal cell carcinoma
- ISK is irritated or inflamed seborrheic keratosis (Wikipedia)
====== Pasted from the patient portal =======
A – Skin, left posterior shoulder, shave biopsy:
Basal cell carcinoma, superficial and invasive.
B – Skin, left mid thoracic paraspinal back, shave biopsy:
Atypical squamous proliferation, transected at the base, suspicious for squamous cell carcinoma (see Comment).
01/07/14 Verified by: [pathologist's name]
B(left mid thoracic paraspinal back) – The biopsy shows some features of inflamed seborrheic keratosis, however, squamous atypia is seen and the architecture is quite complex. The lesion is transected at the base, it is suspicious for squamous cell carcinoma. Multiple deeper levels have been examined. Dr. B has reviewed this case and concurs with this diagnosis.
A – Labeled/Fixative: Left post shoulder, formalin.
Quantity/Size: Single, 0.7 x 0.4 x 0.1 cm.
Tissue Description: Shave of firm white skin.
Sections/Processing: Inked and trisected. (T1)
B – Labeled/Fixative: Left mid T. para back, formalin.
Quantity/Size: Single, 0.8 x 0.7 x 0.1 cm.
Tissue Description: Shave of tan skin with a central flesh-colored dome
Sections/Processing: Inked and quadrisected. (T1) ksb
A – Skin, left posterior shoulder, shave biopsy
Col Date: 1/6/2014 DOB/Sex: 2/18/1950,(63 years),Male
Rec Date: 1/6/2014 LOC:
B – Skin, left mid T para back, shave biopsy
Clinical History: None provided
A – R/O SBCC
B – R/O ISK versus BCC
====== End of pathology report ========