Gracias, amigo. Lo siento. I agree. I hope that these days that blind biopsies are being avoided in favor of MRIs to focus on suspicious lesions. Then, a transperineal is a safer approach--in English or Espanol. Still, it can be hard in some locales in the US to find a urologist who offers the transperineal option. Howard
The ultrasound-guided prostate biopsy whether trans-rectal or trans-perineal and whether asleep or not, is an embarrassingly unscientific test. The 12-core test samples blindly and randomly about 0.1 percent of the prostate - when you add up the volumes of those 12 cores and measure it against the volume of your prostate. That leaves one totally ignorant of what is going on in the 99.9 percent rest of the prostate. A horrible sampling error rate. How ludicrous is that? If there is a benefit to the perineal route for the biopsy it's the fact that there are fewer septic (including deaths) and bleeding complications. All in all, the perineal biopsy is like putting lipstick on a pig - the ultrasound-guided biopsy (whether trans-rectal or perineal and whether asleep or not) is still a pig. This so-called test needs to be thrown out. The best way to detect potentially lethal high-grade disease (and ignore bogus disease) is with an MRI-guided biopsy by an expert - and then get a second opinion on the biopsy results.
Thanks, Tim. Mostly I have heard that transp is covered like transr. Where were you tested? What amount did insurance pay? What did the unpaid part total?
Not an easy question to answer. As we all know, medical billing is a mysterious endeavor. So far, I'm only out $143, +$80; total of $223. [see notes below]. Through more than a dozen pages of explanation of benefits (EOBs) involving several denials, several rebills, and finally a negotiated bundled EOB---> I "think" Dr. Walsh is whole, and the Hospital is whole. But they had to fight for it and this insurance company plan basically says that TP is experimental. I think it worked out like this: Total billed: $6,996.03. Insurance paid: $3,800.20. I paid $143.00. The providers ate the rest. This covers: pre-procedure urologist visit, the in hospital outpatient TP procedure under GA with Fusion guided ultrasound, Initial pathology, and Johns Hopkins 2nd opinion pathology.
Procedure on 1/13/22. Finally all straightened out for me to get a final bill of $63 on 6/19/22.
Additionally, initial telehealth urologist mtg ($40 copay) and preop exams/labs with my PCP ($40 copay)
Where: Dr. Walsh, Titus Regional Medical Center; Mt. Pleasant TX. I have only great things to say about Dr. Walsh and the care I received at Titus.
This procedure was initiated by a area of interest that showed up on my annual MRI last November. I'd been on AS for 2-1/2 years at that point.
An update on my own experience: My Trans-Perineal was done under general anesthesia; as it was a "Fusion" biopsy. This to make sure to accurately sample the area found on the annual MRI. I.E. no moving around and disturbing the process by the patient (me).
Additional data-point: Aetna Medicare Advantage plan still calls it "experimental" so the urologist fee was not covered. But, the rest of the hospital/anesthesiologist/etc. was covered.
Me thinks, another case of urologists (the ones at the insurance company) covering the general business practices of the majority of their fellow practicing urologists.
---I'm still glad I opted for Trans-Perineal. Got good data and no infection. A completely different experience from the TR biopsy.
Thanks for sharing your biopsy experiences, Harry. Similar to my experience sux biopsies in 12 years and none in the past six years. But every guy is different. My feeling is patients should be able to make their own biopsy choice.
I’ve had seven biopsies during my thirteen years in Johns Hopkins’ AS program. The five TRUS were done in exam rooms. The last two were TP, and one was done in an exam room, and one in surgery room. All were done with local anesthesia. No big deal.
Thanks for sharing. Was this with the PrecisionPoint system?
Gracias, amigo. Lo siento. I agree. I hope that these days that blind biopsies are being avoided in favor of MRIs to focus on suspicious lesions. Then, a transperineal is a safer approach--in English or Espanol. Still, it can be hard in some locales in the US to find a urologist who offers the transperineal option. Howard
No mas, no mas por favor!
The ultrasound-guided prostate biopsy whether trans-rectal or trans-perineal and whether asleep or not, is an embarrassingly unscientific test. The 12-core test samples blindly and randomly about 0.1 percent of the prostate - when you add up the volumes of those 12 cores and measure it against the volume of your prostate. That leaves one totally ignorant of what is going on in the 99.9 percent rest of the prostate. A horrible sampling error rate. How ludicrous is that? If there is a benefit to the perineal route for the biopsy it's the fact that there are fewer septic (including deaths) and bleeding complications. All in all, the perineal biopsy is like putting lipstick on a pig - the ultrasound-guided biopsy (whether trans-rectal or perineal and whether asleep or not) is still a pig. This so-called test needs to be thrown out. The best way to detect potentially lethal high-grade disease (and ignore bogus disease) is with an MRI-guided biopsy by an expert - and then get a second opinion on the biopsy results.
Thanks, Tim. Mostly I have heard that transp is covered like transr. Where were you tested? What amount did insurance pay? What did the unpaid part total?
Not an easy question to answer. As we all know, medical billing is a mysterious endeavor. So far, I'm only out $143, +$80; total of $223. [see notes below]. Through more than a dozen pages of explanation of benefits (EOBs) involving several denials, several rebills, and finally a negotiated bundled EOB---> I "think" Dr. Walsh is whole, and the Hospital is whole. But they had to fight for it and this insurance company plan basically says that TP is experimental. I think it worked out like this: Total billed: $6,996.03. Insurance paid: $3,800.20. I paid $143.00. The providers ate the rest. This covers: pre-procedure urologist visit, the in hospital outpatient TP procedure under GA with Fusion guided ultrasound, Initial pathology, and Johns Hopkins 2nd opinion pathology.
Procedure on 1/13/22. Finally all straightened out for me to get a final bill of $63 on 6/19/22.
Additionally, initial telehealth urologist mtg ($40 copay) and preop exams/labs with my PCP ($40 copay)
Where: Dr. Walsh, Titus Regional Medical Center; Mt. Pleasant TX. I have only great things to say about Dr. Walsh and the care I received at Titus.
This procedure was initiated by a area of interest that showed up on my annual MRI last November. I'd been on AS for 2-1/2 years at that point.
An update on my own experience: My Trans-Perineal was done under general anesthesia; as it was a "Fusion" biopsy. This to make sure to accurately sample the area found on the annual MRI. I.E. no moving around and disturbing the process by the patient (me).
Additional data-point: Aetna Medicare Advantage plan still calls it "experimental" so the urologist fee was not covered. But, the rest of the hospital/anesthesiologist/etc. was covered.
Me thinks, another case of urologists (the ones at the insurance company) covering the general business practices of the majority of their fellow practicing urologists.
---I'm still glad I opted for Trans-Perineal. Got good data and no infection. A completely different experience from the TR biopsy.
Thanks for sharing your biopsy experiences, Harry. Similar to my experience sux biopsies in 12 years and none in the past six years. But every guy is different. My feeling is patients should be able to make their own biopsy choice.
I’ve had seven biopsies during my thirteen years in Johns Hopkins’ AS program. The five TRUS were done in exam rooms. The last two were TP, and one was done in an exam room, and one in surgery room. All were done with local anesthesia. No big deal.