Biopsy done someplace other than your tx center

[MooseMom]

I think there was someone here on IHD who mentioned having a biopsy done at his/her local hospital instead of at his/her tx center because of insurance issues; that made me wonder.

Almost exactly a year ago, I had to travel up to UW Madison for a biopsy.  That's where my tx center is; it is out of network for me, so I needed a referral.

They ran labs when I arrived, and once they got my results back, we decided that a biopsy wasn't required, after all.

One year later, I am still wrangling with whoever it is that issues referrals and manages out-of-network charges to get them to pay the claim.  My ins co is fine with paying it, but for whatever reason, these middlemen are doing everything they can to delay paying, even resorting to claiming that what they sent to me wasn't a "referral", rather, it was an "in office memo" despite the fact that the document in question has the words "referral" and "authorization number" on it.   

Anyway, it has all been such a kerfuffle that it made me wonder if anyone here has had a biopsy done at a local hospital instead of fighting the bureaucracy to have it done at an out of network center.  I mean, is it even possible, or did I just imagine that someone here indeed did this?  No one is chasing me to have one done now, but in case my tx team wants me, in the future, to have a biopsy, I would just like to know if it HAS to be done up there.  I mean, can you trust someone at a local hospital to do a biopsy on a transplanted organ?

Anyone?

[iolaire]

At George Washington University Hospital all the biopsy’s get set out to be read/reported on.  Does your program process them on-site? If so do they do something special on the read/reporting side? 

The only thing the GW nephrogist did was look at the sample to insure it had enough tissue. I asked my nephrogist if he could see anything when he looked at it and he said no, the microscope they use is way to low power.

For me and GW I assume it could be done anywhere but they might prefer it’s procceed at the same Hospital that they sent there last biopsy’s to. (For consistency.).

I also think both of my pre transplant biopsy’s were sent out as well.

[Simon Dog]

Here in Boston many hospitals (including small community hospitals) perform renal biopsies, but they are all sent to Brigham & Womens Hospital (BWH) for analysis.

Ditto for monthly transplant labs.

[MooseMom]

Thanks, guys.  You've both hit upon a central issue that I'd been mulling over.  I assume that the actual biopsy could be done anywhere, but I also assume (perhaps wrongly?  I don't know.) that the sample would be sent up to UW Madison, especially since that is the place where they have my donor's tissue if they wanted to see if there was rejection.

So, I'd run into the same problem, insurance wise.  If I had the biopsy done at my local hospital which is "in network", there wouldn't be a problem, but still there would be costs incurred (and probably a referral would be needed) from having UW's HLA lab do a DSA test.  I've had to explain to my HMO each year what a DSA test is and what the HLA lab does, but they just ignore me.

The advantage of having a biopsy done at your tx center would be that if they found something, they could begin treatment immediately, saving one the journey that you'd be trying to avoid in the first place.

BTW, if a mod wants to move this discussion to the Insurance forum, please feel free.

But seriously, this is one problem with our health system that drives up costs.  Having this extra layer of bureaucracy is expensive.  What is so galling is that the middlepeople involved in my care have just flat out lied to me, and I can prove it.  This is why I hang on to every single bit of documentation and make notes of every single telephone conversation I have with these people.  I've sued an insurance company before (although in this case, it is not BCBS-IL's fault.  They've been great, actually.), and I won.  Being a kidney patient is hard enough without the extra battles.

Anyway, thanks, guys.  If anyone else has any experiences with this sort of scenario, I'd be grateful if you'd tell me about it.  Thank you!

[Paul]

Over here the biopsies are always done in hospital. In fact when I was in hospital last week, the two beds opposite me were for biopsies.