The Tab 1

As we all know, bills do have a way of adding up. Medical bills really have a way of adding up. I’ve been waiting for some of the paper trail to follow me from New York to San Francisco. Not all of it has. But I just got the hospital bill from UCSF, and I’ve just got to plunge in. Here’s the partial tab for my breast cancer so far:

7/13/10
St. Luke’s Roosevelt Hospital, New York
$ 780.00, Biopsy pathology, hematological (i.e. blood analysis). Code 88305.

$1,770.00, Immunohistochemistry (IHC) Pathologists use antibodies and dyes to pinpoint certain proteins, called antigens, in the tissue from my core biopsy, different types of cells produce different kinds of antigen, so they can be markers. When normal cells become cancer cells, their antigens change, so that can identify the cancer. Pathologist adds antibodies for known types of cancer to my tissue, then uses dyes and other chemicals to see if the antibodies attach to the tissue. If the antibodies and tissues hook up, you’ve got cancer. Code 88342.

$840.00, Breast Cancer Profile, Using IHC to look for markers that show whether the cells react to estrogen, progesterone, or the protein Her-2 (human epidermal growth factor 2). Code 88360.

$780.00, Needle core biopsy, gross and microscopic examination (i.e. what does it look like with the naked eye, and what does it look like under a microscope). Code 88305, with modifier 59, meaning they took cores in two places.

Running Total:
$ 4,170.00

7/21/10
NYU Breast Center
$ 340.00 Consultation. My first appointment with a breast surgeon.

Running Total:
$ 4,510.00

Missing, bills yet to come from NYU for:
MRI, MRI guided biopsy, Ultrasound fine needle biopsy, several mammograms, genetic testing.

Bills yet to come from Sloan Kettering for:
Consultation, second opinion

9/7/10
$ 786.00 Path Exam, Level 5 (examining tissue from my breast and lymph node) Service code 5100005.

$786.00, Path Exam, Level 5, yet another sample of tissue

$786.00, Path Exam, Level 5, yet another sample

$400.00, Morphometric Analysis, trying to figure out what markers the tissue has, using IHC, dyes etc. Service code 5100190

$400.00, Morphometric Analysis, second sample. Same code.

$400.00, Morphometric Analysis, third sample. Same code.

$ 0.00, Tracking, with H&E stain. Different ways of dying tissue sample. Service code 5107008.

$0.00, Tracking, unstained, recut. Service code 5107011.

$0.00, Tracking, unstained, recut. Service code 5107011. Must be another tissue sample.

$0.00, Tracking, frozen. Service code 5107017. Must have sent some tissue samples off to freezer.

$1,165.00, Post anesthesia care unit, first hour. Service code 5161503.

$1,056.00, Post anesthesia care unit, 96 additional minutes. (They charge by the minute?! Yes they do: $11/minute as a matter of fact.) Service code 5160542.

$786.00, OR, Anesthesia, Initial 30 minutes. Anesthesiologists charge by the minute, too! $26/minute and worth every penny, I’d say. I am haunted by a scene in the HBO mini-series John Adams (based on the David McCullough book) in which they show the prep for Adams’ daughter’s mastectomy in the early 1800s. They tied her down and gave her some laudanum, and a twig to bite on. She still died. Service code 5181101.

$4,401.00, OR, Anesthesia, 163 extra minutes. Amazingly, the extra minutes get a different Service code: 5181104. Didn’t realize I was under for three hours and 12 minutes.

$352.00, Pack Basic Minor. One of those sterilized kits that docs in “ER” and other medical shows are always ripping open dramatically). This one appears to include all kinds of things that I’d rather not think of in conjunction with my own body: Blade No. 101, Blade No. 151, Cautery pencil (This a handle ending in a thin, electrically charged platinum wire used to burn tissue to close off small bleeding vessels. In the past, cautery, after an amputation say, was done with hot irons to stop bleeding and infection. My God, if the patient didn’t just die of the pain first. I’ll stop complaining about the barbarity of modern medicine.) , Medicine cup, drapes, gauze, gowns, lap sponges (laparatomy sponges, rayon and polypropylene sandwiched between two layers of gauze. One website says they’re excellent for “bleeding control and organ protection” during operations. “Laparatomy” means cutting through the abdominal wall. Luckily, breasts are these funny things hung like an afterthought outside the abdomen, so I didn’t have to go through that, even though they had the sponges!), cover needle, needle container, skin scrub tray, ruler for skin marker, skin marker, syringe, cautery tip (tip for the cautery pencil I guess), OR towels (these are cotton, designed for “maximum absorbency” according to one website, Yankauer without vent, (this is a suctioning tool, kind of like the suction tube used at the dentist but this is for blood, and other “fluids.”)

$510.00, Pre-operative service (I guess this is all questionnaires, and blood pressure and temperature checks)

$3,140.00, Level 2, Initial 30 minutes. First bit of the operation. Service code 6340020.

$8,639.00, Level 2, The last 163 minutes of the operation. Surgeons charge by the minute, too, $53/minute! I’m sure the surgeon doesn’t actually receive $53/minute, that’s the hospital charge. But let me just point out that it’s 60 times the going rate for freelance editors. Again, the additional minutes get their own Service code: 6340072.

$2,094.00, This is the base charge for the operating room. Service code 6340082.

$20.19, 30 units of Bacitracin, an antibiotic. A bargain after everything else. Service code 7500170

$2.18, Fluoresce–something or other, hard to make out, guessing it’s a dye or marker for the pathologist. Service code 7502301.

$262.09, Gelatin, probably something in which to embed the pathology samples. Service code 7503791.

$14.51, Bupivacain, 30 units, a local anesthetic. Service code 7500244.

$13.13, Fentanyl, 3 units, a narcotic analgesic (see Vicodin post Service code 7501002.

$14.22, More Fentanyl, injected. Service code 7501003.

$26.40, Lidocaine, another narcotic and local anesthetic, 50 units. Service code 7507710.

$9.75, Metoprolol, 1 mg. A drug used to treat high blood pressure. Not sure why I got that, since I’ve always had low blood pressure. Maybe something to do with anesthesia? Service code 7519015.

$80.02, Muri-lube light mineral oil, 10 units. Not sure what this would be for. Service code 7520450.

$0.77, Vicodin, I remember asking for this in post-op. Service code 7523115.

$0.77, Vicodin, I asked for a second one. Service code 7523115.

$4.60, Midazolam, the NIH says this is given to children before anesthesia. Guess I’m not the most mature surgery patient! It’s related to Valium, part of a family of drugs called “benzodiazepines.” I guess this is the “I don’t give a shit” pill. Service code 7529035.

$175.00, Breast specimen. (A hunk of my left breast. Don’t want to go there.) Service code 8047220.

$175.00, Breast specimen. They did it again. Service code 8047220.

$417.00, Mammogram Needle localization. The lovely wires to guide the surgeon. Service code 8047442.

$417.00, Mammogram Needle localization. More fun, they did it in two spots. Service code 8047442.

$4,067.00, Mammogram Needle localization, internal perforation. It costs a lot more when they shoot that needle in! Service code 8047218.

$4,067.00, The second needle perforation. Costs the same, but gets its own Service code 8047219.

Total for my partial mastectomy:
$35,468.63

Running total:
$39,978.63

A few impressions: Nothing in the hospital is free. Each pill you take has a price tag, and they keep track. Each Vicodin, for instance, costs 77 cents. That’s a bargain in the grand scheme, obviously. My God, I am glad I have excellent health insurance through my husband’s employer. There is no earthly way that my husband and I, two journalists, could afford these medical bills. Thank God I did not get cancer during the one year, 2003, that we did not have health insurance.

And a disclosure: I am totaling the bills the hospitals and doctors initially charge. Each bill will be “discounted” according to each institution’s deal with our health insurer, which happens to be Blue Cross. I have never been able to understand why the discounts are so large. And I have also never understood why the “full price” is charged to individuals who do not have health insurance, and therefore do not have an insurer who can bargain with large hospitals and other providers. Talk about kicking someone when they’re down.

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About leftbreast

I have had breast cancer. I was diagnosed at 47, and am now 49. I have finished "active treatment," two surgeries, chemo, radiation, monoclonal antibodies. These days, I only take a drug to suppress my uptake of estrogen, since my tumor was highly reactive to that hormone. I have been married to my husband Pete for 21 years. I have a stepdaughter, Maureen, 30, and a daughter, Erin, 10. I've been a freelance magazine journalist for 20-plus years, covering everything from Chinese foreign policy to Catholic nuns to endangered species. I have had a great life. I have lived in Asia and all over the United States. I have spent nights with tree-sitters in Oregon and with astronomers at the Mauna Kea observatory in Hawaii. I've been to a cocktail party on the poopdeck of a British destroyer docked in Shanghai. I've taken the bus to Tibet, and tramped through the cloud forests of Panama with biologists. A magazine sent me on a raft trip down the Colorado through the Grand Canyon; another sent me to cooking school for a week. I have spent time with celebrities, presidents and heroin dealers. I love my work. I have a loving, supportive family and more friends than I probably deserve. I have had the space and time to camp, ski, cycle, garden, cook and spoil my pets (an Australian shepherd, a German shepherd and a tabby cat). If it all ended tomorrow, I would have to say that it has been a really, really good ride. When I was in thick of treatment, I was simply fighting for more time. Now, I'm trying to connect the experience of cancer with the rest of my life, with the time that's been won. I hope the cancer never comes back, but if it does, I'll be ready. That's what this blog is about.
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2 Responses to The Tab 1

  1. Beth says:

    Heather, this is amazing. I broke my ankle in March and had the same reaction looking at the bills, above all – no wonder people end up homeless when something happens and they don’t have insurance.

    • leftbreast says:

      Beth, Indeed. Did a story for Family Circle a few years back about a town in North Carolina, Asheville, that decided to institute its own universal healthcare. Great program. But will never forget the folks I interviewed who had devastating health problems because they avoided the doc because they were afraid of the bills. Docs who started the program did so because of a lady who DIED from diabetes, probably two decades before her time, because she didn’t have health insurance and she was afraid to get treatment because of the bills.

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