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Since your specimen will most likely be sent to a pathologist to determine if it is malignant (cancerous) or benign (non-cancerous) you will absorb that cost visiting either specialist type. However, you must ask ahead of time if the pathologist accepts your insurance plan. You'd be surprised how many patients get a whopping bill because the specimen was sent to an out of network pathologist. And, don't forget to always ask for a copy of your pathology results for your own records. Keep in mind that your health record belongs to you and you are entitled to copies of any reports contained in it.
When to see a doctor
So, you have a suspicious lesion and not sure where it came from. There are lesions of various etiology or origin. Maybe, you're predisposed to getting lesions all the time and they've been of no concern. However, you may have noticed a lesion on your body for the first time. Maybe, you spent too much time in the sun. Well, don't panic! It could be nothing to worry about. If you start jumping around from doctor to doctor you'll go broke before you've even addressed your worries. Keep an eye on it. If it starts to change then you need to go to the next step. Some of the changes you may notice is that the lesion has gotten larger or darker. Perhaps, it is now raised above the level of the skin (it's bumpy). Maybe, it's borders which were once perfectly round are now jagged and uneven. These are some signs that you need to seek medical advice. But, do yourself a huge favor - once you've made the decision to see a doctor, do a little homework from the comfort of your couch first. Here's what I mean:
Start from the beginning and call your insurance company to find out if your insurance plan requires a referral to a specialist office. If so, then you will need to visit your primary care physician (PCP) in order to be referred out to a specialist doctor. Generally speaking, your PCP will not remove the lesion for you. If you do not have a health managed insurance then save a co-pay and skip the PCP visit all together. Start researching specialist doctors in your area that do lesion removal. But, beware of the almighty scalpel. It can cut away more than just your lesion. Some doctors will have you returning to the office more times than you can say ouch! Ouch in the wallet that is. Most doctors can determine the course of treatment that you should take just by their interview with you and of course a physical exam.
If you do need to visit your PCP and he or she recommends that the lesion be removed immediately then you need to ask if it's better to see a dermatologist or a surgeon. Believe me there is a BIG difference between the two when it comes to spending your bucks! My suggestion would be to call both types of specialist offices. But, before committing to an office visit ask to speak with the physician's nurse or medical assistant. You need to ask questions. Doing this will save you aggravation. And, you have enough to deal with already. Some of the questions you should ask off the bat are:
- Will there be multiple visits to the office or can the lesion be removed on your first visit?
- Other than your co-pay, (if you have one) are there any additional up front fees?
- How long would it take for the pathology results to come back?
- Will you be called with the pathology results after the physician reviews them?
Dermatologists may perform a biopsy (remove a small specimen) of your lesion during your initial visit to their office and it's all over. No extra fees from them. Unless, your lesion is malignant. Then, of course, you would require additional treatment. Surgeon's on the other hand will most likely schedule a separate surgical visit at a surgical facility. What does this mean for your wallet? Well, let's see...
- For your initial visit you've already paid your "specialist" co-pay and you'll be responsible for the portion of the bill not covered by your insurance. This is your deductible costs.
- Now, you need to return for surgery. There's another co-pay, only this time the co-pay is being paid to either a hospital or ambulatory surgery center which will be much higher than the standard fee.
- Then, there are fees for everyone involved during your surgical procedure. Other costs may include supplies, special equipment and who knows what else can be tossed in there.
Let's take a minute and break it down some more. Your surgeon will bill your insurance carrier his or her surgeon fees for performing the actual procedure. Then, the facility where the procedure takes place will bill your insurance carrier facility fees because the surgeon is using their facility. Then, there's the anesthesiologist (if required) who will bill anesthesia fees. Oh, make no mistake...they want to be paid too. But, you need to watch for "double dipping". Some anesthesia groups use an anesthesiologist and a nurse anesthetist for simple surgeries. This is not always necessary, but it helps them make more money because they charge your insurance company both the anesthesiologist fee and the nurse anesthetist fee. Ask ahead of time if you will require both. If the answer is yes, then ask why it's necessary. You may also request that only one or the other be used and not both. It only makes your out of pocket costs higher when they bill your insurance company this way. Also, get everything in writing. Remember, only you are in charge of your wallet.
But, there's good news out there too. There are some surgical practices that may do a biopsy during your first exam, but you need to confirm this. Again, speak with experienced office staff only. If they seem unsure about the answers to your questions then for goodness sake try another medical practice. The last thing you want to do is show up for a visit and be disappointed to find that you've wasted your time and money. Properly trained staff should have no difficulty answering these simple questions and helping you in making an informed decision regarding your health. A little know how goes a long way!
If you have multiple skin lesions that require removal then make sure that your surgeon or dermatologist will remove all of them at the same visit. Some doctors try to make more money by having you return over and over again. Sure it's good for them, but who has gas to waste driving back and forth. Not to mention, the co-pays and deductible fees you'll be shoveling out. Lesion excision is not a complicated procedure and as I said - some doctors will even do this simple procedure in their office setting. Give yourself the best health care your money can buy, but don't throw your hard earned money away.