As I wrote back in March (https://todddunn.wordpress.com/2016/03/10/my-medical-odssey-part-i/), the cost of a Chronic Lymphocytic Leukemia (CLL) diagnosis is non-trivial. Now that I have actually received the bills and insurance statements I would like to update what I said about costs then. I am going I give the amount billed by the doctor, hospital or lab followed by the amount allowed by my insurance in the format billed/allowed. I am doing that to show two things. First the amount billed is what a person with no health insurance would be expected to pay. My format illustrates the first line saving that having medical insurance provides. Second, the format illustrates how an insurance company values different services. So here goes.
The normal pattern for a CLL diagnosis is that the patient goes to the family doctor for some reason. That reason my be a symptom of CLL, but more likely the reason has little or nothing to do with CLL. No matter what the reason was for the initial visit to the doctor, the doctor orders a blood test (or tests). The blood test comes back with a high white cell count, which starts the CLL diagnosis off.
Here are my costs for the initial doctor visit and the resulting blood tests.
Doctor visit – $176 billed, $140.84 allowed by insurance
Blood draw – $31 billed, $26.35 allowed
Complete Blood Count (CBC) – $75 billed, $63.75 allowed
CBC differential white cell counts – $55 billed, $46.75 allowed
CBC cell scan (manual cell counts) – $47 billed, $39.95 allowed
Blood metabolic panel – $252 billed, $214.20 allowed
So the total costs for my first doctors visit and resulting blood tests were $636 billed and $531.84 allowed by insurance. Overall having insurance saved me $104.16 versus not having insurance.
My doctor hadn’t dealt with any patients with CLL before, so my blood test was a bit of a shock to her since my absolute lymphocyte count was nearly 20 times normal. Consequently, she had me come in for a follow up appointment after which she scheduled an additional complete blood count (CBC) and a chest X-ray. She also called the local hematologist and he suggested that I also have a Flow Cytometry blood test. So I had more blood drawn and the X-ray.
Second Doctor visit costs.
Doctor visit – $116 billed, $94.82 allowed by insurance
Blood draw – $31 billed, $26.35 allowed
Complete Blood Count (CBC) – $75 billed, $63.75 allowed
CBC differential white cell counts – $55 billed, $46.75 allowed
CBC cell scan (manual cell counts) – $47 billed, $39.95 allowed
Flow Cytometry blood test – 160.00 billed, $136 allowed
Blood smear review/pathology – $188 billed, $159.80 allowed
Flow Cytometry Pathology – $196 billed, $110.27 allowed
Chest X-ray (2 views) – $320 billed, $272 allowed
Chest X-ray radiology report – $57 billed, $16.07 allowed
The total cost for my second visit with my family doctor and the resulting tests came to $1,335 billed of which $965.76 was allowed by insurance.
So after two doctors visits with my family doctor and four blood tests my doctor referred me to a hematologist/oncologist. The hematologist/oncologist’s office called me to schedule an appointment and incidentally told me that my test results gave a diagnosis of CLL. At the point of my referral to the hematologist/oncologist my total medical costs were $1,971 billed of which my insurance allowed $1,497.60. Having insurance saved me $473.40. It is worth noting that my insurance company allows about 83.5% of doctor visit billings and lab tests, but only allows about 50% of pathology charges. Clearly my insurance company doesn’t value pathology very highly.
I had my first visit with my hematology/oncology doctor about two weeks later. That visit involved a review of my lab work, a physical exam for symptoms of CLL and orders for more blood tests and CT scans of my chest and abdomen. The costs for my first visit with my cancer doctor are as follows.
Cancer Doctor visit – $528 billed, $448.80 allowed
Blood draw – $31 billed, $26.35 allowed
CBC blood test with auto-differential – $75 billed, $63.75 allowed
CBC cell scan (manual cell counts) – $47 billed, $39.95 allowed
Blood metabolic panel with added uric acid and LDH – $348 billed, $295.80 allowed
FISH blood test (CLL panel) – 1,104 billed, $938.4 allowed
FISH blood test pathology – $878 billed, $363.40 allowed
CT scan chest w/o contrast – $1,599 billed, $1,359.15 allowed
CT scan chest radiology report – $267 billed, $75.16 allowed
CT scan abdomen and pelvis w/o contrast – $3,030 billed, $2,575.50 allowed
CT scan abdomen and pelvis radiology report – $516 billed, $148.80 allowed
So my first visit with my cancer doctor and the resulting test were VERY expensive. The total billed was $8,423 billed of which $6,332.06 was allowed by my insurance company. Again the allowance rate by my insurance company was a bit over 80% for doctors visits and tests but only about 35% for pathology and radiology with radiology costs allowed at only 29%. Clearly my insurance company doesn’t think radiology is worth much.
My CLL diagnosis was completed a month later when I had my second visit with the hematologist/oncologist. I had a CBC blood test just before the visit with the doctor. During that visit he went over my test results, did a quick physical exam, formally put me into “watchful waiting status” and scheduled me for monthly blood tests for the next three months.
The costs for that visit were,
Hematologist/oncologist office visit – $271 billed, $230.35 allowed
Blood draw – $31 billed, $26.35 allowed
Complete Blood Count (CBC) – $75 billed, $63.75 allowed
CBC cell scan (manual cell counts) – $47 billed, $39.95 allowed
My final diagnostic visit cost $424 billed of which $360.40 was allowed by insurance. Overall my full cost to be diagnosed with Chronic Lymphocytic Leukemia was $10,818 billed of which $8,190.06 was allowed by my insurance company.
My continuing costs will depend on how often I see the hematology/oncology doctor and the frequency of my CBC blood tests. At present I am getting monthly CBC blood tests ($153 billed/$130.15 allowed) and seeing toe doctor every three months ($271 billed/$230.35 allowed). If that frequency continues my costs every three months will be $730 billed of which $620.80 will be allowed. On an annual basis that comes to $2,920 billed and $2,403.20 allowed.
At this point I would like to list total costs including pathology and radiology for the various tests I had during my diagnosis. This illustrates the costs of these tests. It is worth noting that all of my tests were done at our local small hospital. The same tests could cost less at a major facility.
Typical CBC blood test with differential white cell count – $153 billed, $130.15 allowed
Standard Blood metabolic Panel – $252 billed, $214.20 allowed
Flow Cytometry blood test with pathology – $544 billed, $397.07 allowed
FISH blood test (CLL panel) with pathology – $1,982 billed, $1301.80 allowed
Chest X-ray (2 views) with radiology report – $377 billed, $288.07 allowed
CT scan chest no contrast with radiology report – $1,865 billed, $1,434.31 allowed
CT scan abdomen+pelvis, no contrast with radiology report – $3,546 billed, 2,724.30 allowed
As I noted above, my insurance company allows a bit over 80% of doctors office visits billing and laboratory tests. In contrast they only allow about 50% of pathology charges and under 30% of radiology interpretation charges. To the extent that my insurance company is typical, it appears that radiology and pathology are under valued relative to actual doctors office visits and lab tests. I find this puzzling since both pathology and radiology are specialties requiring more training than that which a normal GP would have.
At any rate, you can see that being diagnosed for CLL is not a cheap process. In comparison, the continuing costs for “watchful waiting” are relatively cheap. However I am glad I have hit my out of pocket limit on my insurance so the rest of the year won’t cost me anything. I am also glad I will go onto Medicare next year so that the $2,700 for continued watchful waiting will be covered instead of an out of pocket cost due to my high deductible. Treatment, on the other hand is outrageously expensive in that a single treatment series can cost over $100,000. Having cancer is certainly not for the poor, unless they are lucky enough to live in a state that accepted the Medicaid expansion under the affordable care act. In states like Maine, which has not accepted the expansion, the costs of a cancer diagnosis could easily bankrupt a person without significant savings even if they have health insurance (due to high deductibles and out of pocket cost limits).
Todd Dunn 
Just found this because I received the bill for diagnosing CLL. The total for the test was $2,030. 82. I’m on Medicare and will have to pay about $204.00. Why should this test for drawing blood be so expensive? Do you have any idea?
Without seeing the details of the bill I can’t say precisely what is going on. Assuming that you have traditional Medicare, the actual blood tests would be covered at 100% (no copay). Doctor’s bills from pathologists and your personal doctor would be covered at 80% (20% copay). So again assuming that you have traditional Medicare, the bill included $1,020 for medical services (doctor’s fees etc) to generate the $204 copay and $1,030.82 for actual lab tests for which there is no copay. It is all in the details of the bill. I have assumed that you had already met your deductible for Part B ($183 for 2017).
If you had not paid any of your deductible prior to this bill then the copay would include the $183 deductible AND $21 for the 20% copay. In that case the lab work was billed at $1,925.82 with the remaining $105 billed for doctor services.
On the other hand, if you have a Medicare Advantage Plan, then the billing and copay depend on the details of your Medicare advantage plan.
Sorry I can’t be of more help unless you share the details of the bill.