This doesn't make sense to me...

[FLyellowdog]

I just found out I have to have a kidney stone removed. It'll be treated by lithotripsy....The first question the doctor asked me after reading my CAT Scan was, "What kind of insurance to do you have?" When I told him Medicare plus supplemental, he went on to explain the following:

Lithotripsy (which he recommends doing) is usually done in this area via a mobile unit and costs about $5000. However, Medicare won't pay for the mobile unit outpatient procedure because it's a contracted thing so I have to go to an area hospital as an outpatient to have the procedure...at a cost of close to $50,000. It was quite clear how annoyed he was by this, as was I.

It's no wonder Medicare has problems. Stupid.

[sinkingfeeling]

1. Where are you? The national average cost is $17,400.

http://newchoicehealth.com/Directory/Procedure/136/Lithotripsy%20(Kidney%20Stone%20Removal%20Surgery)

[Enrique]

2. maybe there is a reason for the rule

good luck with your procedure. Make sure to post on DU while you are high on painkillers.

[FLyellowdog]

5. With any luck I won't need any...not having the horrendous pain some have.

At least not yet. Hey, I don't need to be high on painkillers to post stupid stuff here. I'm a PRO!

[brush]

3. See another Dr

Get a second opinion. Call Medicare to bet a recommendation on how to proceed but your regular Medicare Part A and B should pay for most of the cost. If you have Medicare plus supplemental you should be fine. The supplemental plans sold by insurance companies are tricky though. Try CareMore for less out-of-pocket expenses, even over AARP's plan.

[porphyrian]

4. It has to do with the regulations.

Hospitals and ambulatory surgery centers are both regulated by AHCA, but the rules may be different for each. Individual doctors and Office Surgery facilities are regulated by DOH (different department). Every state has its own regulations for doctors and medical facilities. Medicare, however, is federal, with its own set of regulations. Rick Scott (Governor, Giant Piece of Shit) has refused to implement any of the Affordable Health Care Act, so there are things happening with that as well. In the meantime, patients suffer.

My wife had multiple lithotripsies and they are much better on the recovery than if they have to open you up, so I would suggest that you go that way if possible and advised by your doctor.

[nanabugg]

6. Doctors write the regulations. AMA is huge. It's ALEC of the medical profession. nt

[porphyrian]

8. No. State Legislatures write the laws. Most states go further and write laws...

...creating administrative boards and giving those boards authority to write rules, which work like laws, within strict guidelines. Doctors must be licensed in a state to practice in that state, and that licensure requires doctors to adhere to both the laws and rules of their profession. Doctors don't write shit with regards to regulations. The AMA is huge and lobbies state congresses, but they don't write regulations either.

Caveat: Most medical boards claim doctors as members, so in that sense, some doctors do write rules.

[FLyellowdog]

7. That's for sure. I had lithotripsy way back in the early 90's and it wasn't bad.

Then in '06 I had the basket retrieval thingy. This stone now is a refugee from the 2006 episode. It's always something and it COULD be a lot worse.

Thanks for all the info.

P.S. Rick Scott is a MONSTER Giant Piece of Shit