› Forums › General Melanoma Community › Cost of melanoma surgery
- This topic has 30 replies, 4 voices, and was last updated 11 years, 4 months ago by
lou2.
- Post
-
- December 11, 2012 at 10:11 pm
Doctor's office called to explain costs involved in surgery tomorrow. It seemed very high to me – $1000. Small city in the south, where one might expect not to pay a premium like a big city elsewhere. Board certified dermatologist but not derm onchologist.
It is a small spot recently diagnosed for the first time. Details:
Malignant melanoma lentigo maligna type
Breslow thickness 0.15 mm
Clarks level II
Mitotic rate zero
etc.
Doctor's office called to explain costs involved in surgery tomorrow. It seemed very high to me – $1000. Small city in the south, where one might expect not to pay a premium like a big city elsewhere. Board certified dermatologist but not derm onchologist.
It is a small spot recently diagnosed for the first time. Details:
Malignant melanoma lentigo maligna type
Breslow thickness 0.15 mm
Clarks level II
Mitotic rate zero
etc.
Note on pathology report that it will be a 20 mm excision. This is quite a bit bigger than the spot.
And a separate question. Seems like biopsy of melanoma that is restricted to the surface, not deep, might spread these cells into deeper skin layers. Is this something to worry about?
- Replies
-
-
- December 11, 2012 at 10:32 pm
You asked a good question but no, the biopsy does not spread the cancer into deeper layers. As a matter of fact, it sounds like you caught yours very early and the procedure you are having should eliminate all of the cancer cells. Your chance of recurrance is very low.
As for the cost, I don't know because my brother's biopsies were performed at the VA so he didn't get a bill.
I like your observation about the cost. As you say, "Is this a reasonable charge for this procedure:" You made me think about the Republicans' contention that the way to lower health care costs is to give everyone a predetermined amount of money to spend on healthcare in the form of vouchers and let the patients shop around for the best care or the cheapest rate. I guess their plan is that if people like you think that $1000 is too much for a WLE, you just won't have the surgery. You will then shop around from doctor to doctor to try to find one that costs less. That will force the doctors and medical centers to lower their rates so they can compete for your business. If you decide to go that route, please let us know how it works out for you.
-
- December 11, 2012 at 10:32 pm
You asked a good question but no, the biopsy does not spread the cancer into deeper layers. As a matter of fact, it sounds like you caught yours very early and the procedure you are having should eliminate all of the cancer cells. Your chance of recurrance is very low.
As for the cost, I don't know because my brother's biopsies were performed at the VA so he didn't get a bill.
I like your observation about the cost. As you say, "Is this a reasonable charge for this procedure:" You made me think about the Republicans' contention that the way to lower health care costs is to give everyone a predetermined amount of money to spend on healthcare in the form of vouchers and let the patients shop around for the best care or the cheapest rate. I guess their plan is that if people like you think that $1000 is too much for a WLE, you just won't have the surgery. You will then shop around from doctor to doctor to try to find one that costs less. That will force the doctors and medical centers to lower their rates so they can compete for your business. If you decide to go that route, please let us know how it works out for you.
-
- December 11, 2012 at 10:58 pm
Well, that was one of the objections to the shop around idea. People with cancer don't typically do that, and even if they wanted to, they do not have enough information or background to be a good judge of what is quality care. Really, trying to find out whether any doctor provides quality care is nearly impossible. The same thing could be said about labs and hospitals. Informed consumers in medical care are few and far between. And what are the stats on various treatment successes. We don't know.
I am not opposed to doctors making an adequate income. My question had more to do with what typical costs for such surgery might be, as I have no previous experience with this. And I don't think this will be the only problem place. Am going to a derm oncologist in January for a more thorough look, as the PA who did find this place only looked at those spots I pointed out.
-
- December 11, 2012 at 10:58 pm
Well, that was one of the objections to the shop around idea. People with cancer don't typically do that, and even if they wanted to, they do not have enough information or background to be a good judge of what is quality care. Really, trying to find out whether any doctor provides quality care is nearly impossible. The same thing could be said about labs and hospitals. Informed consumers in medical care are few and far between. And what are the stats on various treatment successes. We don't know.
I am not opposed to doctors making an adequate income. My question had more to do with what typical costs for such surgery might be, as I have no previous experience with this. And I don't think this will be the only problem place. Am going to a derm oncologist in January for a more thorough look, as the PA who did find this place only looked at those spots I pointed out.
-
- December 11, 2012 at 10:58 pm
Well, that was one of the objections to the shop around idea. People with cancer don't typically do that, and even if they wanted to, they do not have enough information or background to be a good judge of what is quality care. Really, trying to find out whether any doctor provides quality care is nearly impossible. The same thing could be said about labs and hospitals. Informed consumers in medical care are few and far between. And what are the stats on various treatment successes. We don't know.
I am not opposed to doctors making an adequate income. My question had more to do with what typical costs for such surgery might be, as I have no previous experience with this. And I don't think this will be the only problem place. Am going to a derm oncologist in January for a more thorough look, as the PA who did find this place only looked at those spots I pointed out.
-
- December 11, 2012 at 11:40 pm
Oh, patients should absolutely be interested in the cost of their medical care! I always read my bills and see what's what. One thing that always amazes me is how much of a discount hospitals give to the insurance companies. For example, the hosptial might charge a private patient (like you) $1000 for a biopsy but the same hospital will accept $500 from an insurance company. That's right there in the bills and the insurance company's "Explanation of Benefits".
But as you point out, without having any way to determine if the provider is "good" and the charges are reasonable, what are we supposed to do with the cost information? And in many situations, the medical condition is urgent enough that we don't have time to mess around and shop around for medical treatment. I'm not trying to argue with you or anyone else. I just scratch my head trying to figure out how a voucher system could possibly work for the average American.
-
- December 11, 2012 at 11:40 pm
Oh, patients should absolutely be interested in the cost of their medical care! I always read my bills and see what's what. One thing that always amazes me is how much of a discount hospitals give to the insurance companies. For example, the hosptial might charge a private patient (like you) $1000 for a biopsy but the same hospital will accept $500 from an insurance company. That's right there in the bills and the insurance company's "Explanation of Benefits".
But as you point out, without having any way to determine if the provider is "good" and the charges are reasonable, what are we supposed to do with the cost information? And in many situations, the medical condition is urgent enough that we don't have time to mess around and shop around for medical treatment. I'm not trying to argue with you or anyone else. I just scratch my head trying to figure out how a voucher system could possibly work for the average American.
-
- December 12, 2012 at 1:51 am
Thanks for your reply. I don't think we are disagreeing. While it might be nice to be a better medical consumer, it is hard to see how that could be done in a situation like this. I always have to laugh when reading those long lists of what patients are supposed to do to remain safe in a hospital. Sick people are supposed to bring their checklist???
On my second question about the biopsy spreading the malignant cells, it seems that it was not so far off the mark. Some types of biopsy are better than others, and here is what is said about one type:
"Punch biopsies are contraindicated in suspected melanomas, for fear of seeding tumour cells and hastening the spread of the malignant cells."
Since this place was on my back, I did not see the instrument that was used and don't know if it was a punch biopsy. Hope not! I will find out tomorrow.
-
- December 12, 2012 at 1:51 am
Thanks for your reply. I don't think we are disagreeing. While it might be nice to be a better medical consumer, it is hard to see how that could be done in a situation like this. I always have to laugh when reading those long lists of what patients are supposed to do to remain safe in a hospital. Sick people are supposed to bring their checklist???
On my second question about the biopsy spreading the malignant cells, it seems that it was not so far off the mark. Some types of biopsy are better than others, and here is what is said about one type:
"Punch biopsies are contraindicated in suspected melanomas, for fear of seeding tumour cells and hastening the spread of the malignant cells."
Since this place was on my back, I did not see the instrument that was used and don't know if it was a punch biopsy. Hope not! I will find out tomorrow.
-
- December 12, 2012 at 3:50 am
Actually, many of us here prefer punch biopsies if the punch can remove the entire lesion. Punch biopsies have the advantage that they will get the complete depth of a melanoma lesion — and depth is the key factor in staging. Shave biopsies are often done quite shallow and can cut through a melanoma lesion leaving the person with an unknown final depth. If your lesion had stitches, it was likely you had a punch. If you didn't have stitches, it was more likely a shave biopsy. Shave biopsies are done quite often because they are quick and easy, but I personally won't allow anyone to do that type of biopsy on me anymore. There are pros and cons with each type of biopsy technique and some times you just have to make an educated choice.
As for the cost of the procedure, that's probably not unreasonable. I remember one of mine costing about $600 or so, but that was many years ago. I am assuming that you will be having this done with local anesthesia. Some people have theirs done under general anesthesia and the cost of that procedure would be significantly more.
In addition, the 20mm margins is a bit misleading. Basically, you want 1cm margins around the entire lesion. So 20 mm would essentially be the width of the tissue removed. However, the length will be significantly more. In order to close the skin, a lesion's length will be about 3 times the width. This does depend on anatomical location as some places may require more/less.
Best wishes,
Janner
-
- December 12, 2012 at 3:50 am
Actually, many of us here prefer punch biopsies if the punch can remove the entire lesion. Punch biopsies have the advantage that they will get the complete depth of a melanoma lesion — and depth is the key factor in staging. Shave biopsies are often done quite shallow and can cut through a melanoma lesion leaving the person with an unknown final depth. If your lesion had stitches, it was likely you had a punch. If you didn't have stitches, it was more likely a shave biopsy. Shave biopsies are done quite often because they are quick and easy, but I personally won't allow anyone to do that type of biopsy on me anymore. There are pros and cons with each type of biopsy technique and some times you just have to make an educated choice.
As for the cost of the procedure, that's probably not unreasonable. I remember one of mine costing about $600 or so, but that was many years ago. I am assuming that you will be having this done with local anesthesia. Some people have theirs done under general anesthesia and the cost of that procedure would be significantly more.
In addition, the 20mm margins is a bit misleading. Basically, you want 1cm margins around the entire lesion. So 20 mm would essentially be the width of the tissue removed. However, the length will be significantly more. In order to close the skin, a lesion's length will be about 3 times the width. This does depend on anatomical location as some places may require more/less.
Best wishes,
Janner
-
- December 12, 2012 at 3:50 am
Actually, many of us here prefer punch biopsies if the punch can remove the entire lesion. Punch biopsies have the advantage that they will get the complete depth of a melanoma lesion — and depth is the key factor in staging. Shave biopsies are often done quite shallow and can cut through a melanoma lesion leaving the person with an unknown final depth. If your lesion had stitches, it was likely you had a punch. If you didn't have stitches, it was more likely a shave biopsy. Shave biopsies are done quite often because they are quick and easy, but I personally won't allow anyone to do that type of biopsy on me anymore. There are pros and cons with each type of biopsy technique and some times you just have to make an educated choice.
As for the cost of the procedure, that's probably not unreasonable. I remember one of mine costing about $600 or so, but that was many years ago. I am assuming that you will be having this done with local anesthesia. Some people have theirs done under general anesthesia and the cost of that procedure would be significantly more.
In addition, the 20mm margins is a bit misleading. Basically, you want 1cm margins around the entire lesion. So 20 mm would essentially be the width of the tissue removed. However, the length will be significantly more. In order to close the skin, a lesion's length will be about 3 times the width. This does depend on anatomical location as some places may require more/less.
Best wishes,
Janner
-
- December 12, 2012 at 1:51 am
Thanks for your reply. I don't think we are disagreeing. While it might be nice to be a better medical consumer, it is hard to see how that could be done in a situation like this. I always have to laugh when reading those long lists of what patients are supposed to do to remain safe in a hospital. Sick people are supposed to bring their checklist???
On my second question about the biopsy spreading the malignant cells, it seems that it was not so far off the mark. Some types of biopsy are better than others, and here is what is said about one type:
"Punch biopsies are contraindicated in suspected melanomas, for fear of seeding tumour cells and hastening the spread of the malignant cells."
Since this place was on my back, I did not see the instrument that was used and don't know if it was a punch biopsy. Hope not! I will find out tomorrow.
-
- December 11, 2012 at 11:40 pm
Oh, patients should absolutely be interested in the cost of their medical care! I always read my bills and see what's what. One thing that always amazes me is how much of a discount hospitals give to the insurance companies. For example, the hosptial might charge a private patient (like you) $1000 for a biopsy but the same hospital will accept $500 from an insurance company. That's right there in the bills and the insurance company's "Explanation of Benefits".
But as you point out, without having any way to determine if the provider is "good" and the charges are reasonable, what are we supposed to do with the cost information? And in many situations, the medical condition is urgent enough that we don't have time to mess around and shop around for medical treatment. I'm not trying to argue with you or anyone else. I just scratch my head trying to figure out how a voucher system could possibly work for the average American.
-
- December 11, 2012 at 10:32 pm
You asked a good question but no, the biopsy does not spread the cancer into deeper layers. As a matter of fact, it sounds like you caught yours very early and the procedure you are having should eliminate all of the cancer cells. Your chance of recurrance is very low.
As for the cost, I don't know because my brother's biopsies were performed at the VA so he didn't get a bill.
I like your observation about the cost. As you say, "Is this a reasonable charge for this procedure:" You made me think about the Republicans' contention that the way to lower health care costs is to give everyone a predetermined amount of money to spend on healthcare in the form of vouchers and let the patients shop around for the best care or the cheapest rate. I guess their plan is that if people like you think that $1000 is too much for a WLE, you just won't have the surgery. You will then shop around from doctor to doctor to try to find one that costs less. That will force the doctors and medical centers to lower their rates so they can compete for your business. If you decide to go that route, please let us know how it works out for you.
-
- December 13, 2012 at 4:02 pm
Sounds low actually. My office visit was $600.00 for a heat to toe checkup. 4 moles removed was $400.00. Same 4 moles sent to lab for pathology-$150.00 each. Surgery for 2 moles and one dysplastic nevus- about $3000.00.
Total bill $4600.00.
-
- December 14, 2012 at 2:41 am
Well, I had the excision. They were lacking some chemical that goes into the local anesthesia to make it painless administration. But they did it anyway and stuck me about 6 times, stinging every time. Unless this is some system wide shortage (how could there be a shortage of sodium bicarbonate?), then I think this was a bad practice. The purpose of anesthesia is to make the process painless!!!
And I go back tomorrow to get dressing changed, told to bring my own bandage!
Had to ask about any weight lifting restrictions.
Don't think I am getting my money's worth, and don't plan to go back to this place after the stitches are removed. Have an appt. mid January at distant derm oncologist to have more thorough check of skin everywhere.
Wondering now if there are staph infection problems with these wounds.
-
- December 14, 2012 at 2:41 am
Well, I had the excision. They were lacking some chemical that goes into the local anesthesia to make it painless administration. But they did it anyway and stuck me about 6 times, stinging every time. Unless this is some system wide shortage (how could there be a shortage of sodium bicarbonate?), then I think this was a bad practice. The purpose of anesthesia is to make the process painless!!!
And I go back tomorrow to get dressing changed, told to bring my own bandage!
Had to ask about any weight lifting restrictions.
Don't think I am getting my money's worth, and don't plan to go back to this place after the stitches are removed. Have an appt. mid January at distant derm oncologist to have more thorough check of skin everywhere.
Wondering now if there are staph infection problems with these wounds.
-
- December 14, 2012 at 11:26 am
Oh, my! What a nasty experience! I would NEVER go back to a practice like that–not even to get the dressing changed. I would find another doctor to do that. I have to wonder if your concern about the cost was your subconscious telling you that this was not a practice to be trusted. Next time, trust your instincts!
-
- December 14, 2012 at 11:26 am
Oh, my! What a nasty experience! I would NEVER go back to a practice like that–not even to get the dressing changed. I would find another doctor to do that. I have to wonder if your concern about the cost was your subconscious telling you that this was not a practice to be trusted. Next time, trust your instincts!
-
- December 14, 2012 at 11:26 am
Oh, my! What a nasty experience! I would NEVER go back to a practice like that–not even to get the dressing changed. I would find another doctor to do that. I have to wonder if your concern about the cost was your subconscious telling you that this was not a practice to be trusted. Next time, trust your instincts!
-
- December 14, 2012 at 2:41 am
Well, I had the excision. They were lacking some chemical that goes into the local anesthesia to make it painless administration. But they did it anyway and stuck me about 6 times, stinging every time. Unless this is some system wide shortage (how could there be a shortage of sodium bicarbonate?), then I think this was a bad practice. The purpose of anesthesia is to make the process painless!!!
And I go back tomorrow to get dressing changed, told to bring my own bandage!
Had to ask about any weight lifting restrictions.
Don't think I am getting my money's worth, and don't plan to go back to this place after the stitches are removed. Have an appt. mid January at distant derm oncologist to have more thorough check of skin everywhere.
Wondering now if there are staph infection problems with these wounds.
-
Tagged: cutaneous melanoma
- You must be logged in to reply to this topic.