How much does a breast biopsy cost, $1,000 or $2,342? She saved $1,842

Filed Under: Costs, Health plans, Patients

A community member shared this:

PROCEDURE: 77031 Stereotact guide for brst bx

PRICES:
CHARGED: 1000.0
INSURED: 500.0
PAID: 500.0
REPORT DATE: 2019-03-01

SHARE DATE: 2019-03-01 22:54:27 UTC

HOSPITAL: Houston Medical Imaging

INSURER: Blue Cross Blue Shield of Texas

OTHER INSURER: An employer

INPUT BY: xxxxx

PHONE: xxxx

NOTES:

MD Anderson Breast Care with Memorial Hermann – Memorial City was charging $ 2,342.00 for my out of pocket insurance benefits.

What I asked

A few questions:

1. Can you tell us about the circumstances? Was this a biopsy procedure?
2. Do you have an explanation of benefits or bill you could share with us? Please feel free to black out any identifying details.
3. You said in the notes that they charged $2,342 for your out-of-pocket benefits. Was that their total charge for this, out of which the insurer paid $500 and you paid $500?
4. Were there any other charges associated with this? We think this is one part of a biopsy procedure, and there could be/should be several other bills.

We hope your health is OK.

Thank you very much for your help!

How she replied:

Hi Jeanne

Thanks for reaching out. I wanted to make this public so I can help others finding same service for less of some facilities are charging for the same procedure.

When I was told that a biopsy will be needed, I did not think that I could have done it because of the affordability.

My insurance is BlueCross BlueShield of Texas – PPO plan I have thru my employer since 2009.

I have a copay (out of pocket expenses) of $3,000/year. So they pay for what ACA mandates such as 1 mammogram /year, etc and for these I will not have any out of pocket expenses.

Some breast calcifications were detected in 2016 and I had ultrasound and mammograms scheduled every 6 months to monitor these calcifications. On the second anniversary of this monitoring, the radiologist at MD Anderson Breast Care with Memorial Hermann – Memorial City requested a STEREOTACTIC Biopsy of the right breast and they stated that my insurance could not cover it. My out of pocket amount for this procedure would be $ 2,342.00.

Since I could not afford it, I got all copies and images since 2017 from them and started sourcing for an alternative.

I used Houston Medical Imaging in 2012 for a thyroid biopsy and found that services were excellent and pricing was very fair. So I took all records to them and got an estimate:

$ 1,000 for the biopsy procedure (see details below) for self pay. Using my insurance benefits I was able to pay only $ 507.50 out of pocket.

Note 1: Lab costs for pathology is not included. I have not got the bill yet and maybe it will be covered by my insurance.

Note 2: I did not wait for others estimates (The Rose Center in Houston and Solis Radiology in Houston). Maybe I could have paid less but I did not want to prolong or procrastinate any longer.

Services done:

Let me know should you need further information.

I asked if I could post her email, and she replied

Yes, you can share my story. Please keep me as an anonymous contributor.

One more thing: I found your website thru TV news channel 2 (KPRC) here in Houston . When I tried to find more about this procedure, I noticed it was was lacking specifics and pricing range was between $1,000 – $ 6,000.

Hopefully this post will help more people to bend the system or change it entirely. A huge dream but achievable in my opinion.

By the way, biopsy came clear. It is a benign mass.