Any idea the cost for CRS/HIPEC at MSK if insurance not cover out of network?

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tbt4snow
Posts: 21
Joined: Sat Oct 27, 2018 3:16 pm
Facebook Username: Tina tran

Any idea the cost for CRS/HIPEC at MSK if insurance not cover out of network?

Postby tbt4snow » Thu Mar 14, 2019 10:19 am

I just wonder if anyone has run into this problem and find out roughly how much it would cost to have this procedure done at MSK?
Thank you,
Tina.
DX: CC stage 4/w ovaries & omentum mets in 12/17 49/F
High grade pT3N1bM1b sigmoid Adenocarcinoma colon
MSS-h TMB=16, NRAS-mutant
Lymph nodes: 1/2 left colic; 3/8 regional
12/2017: Exploratory laparotomy & resect of sigmoid & ovaries
Folfox/avastin 12 sessions from 1/8-6/18. 6/18 CEA 2.1
1/19: CT shows peri mets;
CEA: 12/18 5.1, 1/7/19 7.9; 1/15/19 9.1; 1/30/19: 10.6
4/3/2019 CRS/HIPEC after 4 Folfiry sessions...

Pyro70
Posts: 118
Joined: Mon Jan 21, 2019 4:25 pm

Re: Any idea the cost for CRS/HIPEC at MSK if insurance not cover out of network?

Postby Pyro70 » Thu Mar 14, 2019 3:31 pm

Sorry, I don’t know what the cost for the total surgery would be at MSK. But you could ask them. Mind you, though, it’s really hard to estimate the total cost since the cost depends largely upon how long your recovery is and length of hospital stay.

So the insurance will only not cover it because it’s out of network? Is there an in-network option? If not, can you get the insurance to get an exception because there is no in-network option? Doing the whole procedure out of network will be prohibitively expensive. You could consider “moving” to New York and signing up for an ACA plan under special enrollment to get in-network coverage. Getting an apartment and paying the deductible for a new plan is likely cheaper than paying out of network costs. Also if you suffer complications and get stuck in the hospital you/your family wouldn’t be on the hook for endless medical bills.
Dx Jan 2017 stage IVB w/ PC age 35
FOLFOX
SEP 17 HIPEC 1, anastamosis leak
XELODA
MAR 18 HIPEC 2
JUN 18, ileo reversal and 2nd anastamosis leak

Pyro70
Posts: 118
Joined: Mon Jan 21, 2019 4:25 pm

Re: Any idea the cost for CRS/HIPEC at MSK if insurance not cover out of network?

Postby Pyro70 » Thu Mar 14, 2019 3:38 pm

Also please be aware all HIPEC studies have been negative. I would consider getting CRS without HIPEC.
Dx Jan 2017 stage IVB w/ PC age 35
FOLFOX
SEP 17 HIPEC 1, anastamosis leak
XELODA
MAR 18 HIPEC 2
JUN 18, ileo reversal and 2nd anastamosis leak

tbt4snow
Posts: 21
Joined: Sat Oct 27, 2018 3:16 pm
Facebook Username: Tina tran

Re: Any idea the cost for CRS/HIPEC at MSK if insurance not cover out of network?

Postby tbt4snow » Thu Mar 14, 2019 4:55 pm

Thank you Pyro70. I have an option to go with local surgeon. But from what I read so far, the CRS is a very extensive procedure and you would benefit greatly if you go with an experienced surgeon. At MSK, I will have Dr. Nash. My local surgeon is board certified in 2013. I saw a negative review on the surgeon from vitals. com. That scared me off greatly. From your signature, you have done HIPEC twice. Did you have it done as MSK? You don't think HIPEC will help much with peri met from CC?
Thanks, Tina.
DX: CC stage 4/w ovaries & omentum mets in 12/17 49/F
High grade pT3N1bM1b sigmoid Adenocarcinoma colon
MSS-h TMB=16, NRAS-mutant
Lymph nodes: 1/2 left colic; 3/8 regional
12/2017: Exploratory laparotomy & resect of sigmoid & ovaries
Folfox/avastin 12 sessions from 1/8-6/18. 6/18 CEA 2.1
1/19: CT shows peri mets;
CEA: 12/18 5.1, 1/7/19 7.9; 1/15/19 9.1; 1/30/19: 10.6
4/3/2019 CRS/HIPEC after 4 Folfiry sessions...

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betsydoglover
Posts: 967
Joined: Mon Aug 14, 2006 2:31 pm
Facebook Username: Betsy Lindh Williams
Location: Maryland - outside DC

Re: Any idea the cost for CRS/HIPEC at MSK if insurance not cover out of network?

Postby betsydoglover » Thu Mar 14, 2019 5:51 pm

I have no idea of the cost or what your ins will cover. However, if you want to go this route, Washington Hospital Center in DC is big in the cytoreduction surgery/HIPEC area. In fact Dr. Paul Sugarbaker who is there is the one who invented the procedure.

So, this might be another choice.
Take care,
Betsy
diag. Stage IV, 5/05, liver met
lap sigmoid colectomy, 6/05
6 cycles Xeloda/oxaliplatin/Avastin (NED after 2)
11/08 9x13mm right lower lobe lung nodule; removed via VATS 4/09
NED
6 cycles Xeloda + Avastin
Avastin only 10/09-5/11
Still NED 06/18

Pyro70
Posts: 118
Joined: Mon Jan 21, 2019 4:25 pm

Re: Any idea the cost for CRS/HIPEC at MSK if insurance not cover out of network?

Postby Pyro70 » Thu Mar 14, 2019 6:19 pm

tbt4snow wrote:Thank you Pyro70. I have an option to go with local surgeon. But from what I read so far, the CRS is a very extensive procedure and you would benefit greatly if you go with an experienced surgeon. At MSK, I will have Dr. Nash. My local surgeon is board certified in 2013. I saw a negative review on the surgeon from vitals. com. That scared me off greatly. From your signature, you have done HIPEC twice. Did you have it done as MSK? You don't think HIPEC will help much with peri met from CC?
Thanks, Tina.



CRS is a very extensive surgery and you should want to go with a team that is very experienced at a high volume center. I used Dr Berri in Michigan, who happens to be local for me. He does a lot of HIPEC and is likely No. 2 in terms of volume in the US. I have high expectations of surgeons, and I was impressed by his level of dedication. I’m sure though there are other surgeons that are just as good at this procedure.

The best data we now have is from Prodige 7, it compared CRS only to CRS with HIPEC. It showed no survival benefit for the HIPEC arm with the exception maybe of people with a medium PCI. Given this data, and the other trial that looked at adjuvant HIPEC, I think we have to assume HIPEC is not helpful for CRC patients, however, CRS propably is (we don’t know for sure). On the other hand HIPEC doesn’t have too many complications so maybe it’s worth a shot especially if you have a medium PCI.

If i were you i would look into getting an insurance that has coverage for a high volume center that does CRS. This can get very expensive without insurance. You also don’t have to do the surgery, systemic chemo only is a legitimate choice, especially if you are asymptomatic.

https://www.onclive.com/conference-cove ... vanced-crc
Dx Jan 2017 stage IVB w/ PC age 35
FOLFOX
SEP 17 HIPEC 1, anastamosis leak
XELODA
MAR 18 HIPEC 2
JUN 18, ileo reversal and 2nd anastamosis leak

tbt4snow
Posts: 21
Joined: Sat Oct 27, 2018 3:16 pm
Facebook Username: Tina tran

Re: Any idea the cost for CRS/HIPEC at MSK if insurance not cover out of network?

Postby tbt4snow » Thu Mar 14, 2019 8:19 pm

Thank you Betsy and Pyro70. I will continue with systemic chemo for now until I find a suitable surgical solution.
DX: CC stage 4/w ovaries & omentum mets in 12/17 49/F
High grade pT3N1bM1b sigmoid Adenocarcinoma colon
MSS-h TMB=16, NRAS-mutant
Lymph nodes: 1/2 left colic; 3/8 regional
12/2017: Exploratory laparotomy & resect of sigmoid & ovaries
Folfox/avastin 12 sessions from 1/8-6/18. 6/18 CEA 2.1
1/19: CT shows peri mets;
CEA: 12/18 5.1, 1/7/19 7.9; 1/15/19 9.1; 1/30/19: 10.6
4/3/2019 CRS/HIPEC after 4 Folfiry sessions...

tbt4snow
Posts: 21
Joined: Sat Oct 27, 2018 3:16 pm
Facebook Username: Tina tran

Re: Any idea the cost for CRS/HIPEC at MSK if insurance not cover out of network?

Postby tbt4snow » Mon Mar 18, 2019 8:48 pm

Just update on my CRS/HIPEC treatment plan. I'm scheduled to have this procedure done at MGH with Dr. James Cusack. I was offered to participate in the study using LUM imaging system for detecting cancer cells during the surgery. This study was done for Breast cancer ( https://clinicaltrials.gov/ct2/show/NCT03686215 ) and I will be the first to try for peritoneal surface Malignancies in CC patient.
I am nervous because the CRS is an extensive procedure and adding LUM015 dye to my body with unknown side effect then heated chemo?
I'm debating should I go with this study or opt out? Any suggestion?
Thanks.
DX: CC stage 4/w ovaries & omentum mets in 12/17 49/F
High grade pT3N1bM1b sigmoid Adenocarcinoma colon
MSS-h TMB=16, NRAS-mutant
Lymph nodes: 1/2 left colic; 3/8 regional
12/2017: Exploratory laparotomy & resect of sigmoid & ovaries
Folfox/avastin 12 sessions from 1/8-6/18. 6/18 CEA 2.1
1/19: CT shows peri mets;
CEA: 12/18 5.1, 1/7/19 7.9; 1/15/19 9.1; 1/30/19: 10.6
4/3/2019 CRS/HIPEC after 4 Folfiry sessions...

Pyro70
Posts: 118
Joined: Mon Jan 21, 2019 4:25 pm

Re: Any idea the cost for CRS/HIPEC at MSK if insurance not cover out of network?

Postby Pyro70 » Mon Mar 18, 2019 9:11 pm

tbt4snow wrote:Just update on my CRS/HIPEC treatment plan. I'm scheduled to have this procedure done at MGH with Dr. James Cusack. I was offered to participate in the study using LUM imaging system for detecting cancer cells during the surgery. This study was done for Breast cancer ( https://clinicaltrials.gov/ct2/show/NCT03686215 ) and I will be the first to try for peritoneal surface Malignancies in CC patient.
I am nervous because the CRS is an extensive procedure and adding LUM015 dye to my body with unknown side effect then heated chemo?
I'm debating should I go with this study or opt out? Any suggestion?
Thanks.


So disclaimer, obviously since this is a trial we/I don’t know the efficacy or side effects. But, without having researched it, doing something like LUM015 is sensible. Pretty much everyone agrees the key to a successful CRS with or without HIPEC, is removing all macroscopic disease so LUM seems like a sensible idea. Also clinical trials tend to be a more controlled environment which leads to better outcomes. Personally I would opt for CRS with LUM and no HIPEC, but I guess this isn’t possible. I’m sure the trial sponsors have done their homework that LUM won’t have a bad interaction with HIPEC drugs, and should be able to alleviate your concerns. Does this resolve your issues with reimbursement?
Dx Jan 2017 stage IVB w/ PC age 35
FOLFOX
SEP 17 HIPEC 1, anastamosis leak
XELODA
MAR 18 HIPEC 2
JUN 18, ileo reversal and 2nd anastamosis leak

tbt4snow
Posts: 21
Joined: Sat Oct 27, 2018 3:16 pm
Facebook Username: Tina tran

Re: Any idea the cost for CRS/HIPEC at MSK if insurance not cover out of network?

Postby tbt4snow » Tue Mar 19, 2019 11:25 am

Hi Pyro70,
I'm all set with the insurance concern. The trial specific for peri met is https://clinicaltrials.gov/ct2/show/NCT ... ell&rank=3 .
I raised my concern with the doctor and was told that they have not seen that the LUM015 affects any post-operative chemotherapy on Breast cancer patients.
Quote "We do not expect that the LUM015 will interfere with the effectiveness of the HIPEC treatment in any way, but we do not know for certain. Because the LUM015 is simply a dye, Dr. Cusack expects that the HIPEC treatment will be as effective as it would be if you did not have the LUM015 injection."
I am hopeful this technic is as effective to detect cancer cells in peritoneum as it is in breast cancer.
DX: CC stage 4/w ovaries & omentum mets in 12/17 49/F
High grade pT3N1bM1b sigmoid Adenocarcinoma colon
MSS-h TMB=16, NRAS-mutant
Lymph nodes: 1/2 left colic; 3/8 regional
12/2017: Exploratory laparotomy & resect of sigmoid & ovaries
Folfox/avastin 12 sessions from 1/8-6/18. 6/18 CEA 2.1
1/19: CT shows peri mets;
CEA: 12/18 5.1, 1/7/19 7.9; 1/15/19 9.1; 1/30/19: 10.6
4/3/2019 CRS/HIPEC after 4 Folfiry sessions...

radnyc
Posts: 369
Joined: Tue Apr 06, 2010 6:32 pm

Re: Any idea the cost for CRS/HIPEC at MSK if insurance not cover out of network?

Postby radnyc » Tue Mar 19, 2019 4:06 pm

Whatever it is, it won't be cheap!
DX Jan '10, at 47
Feb - colon resection - 2/17 nodes
April - liver mets - Stage 4
3 months Folfox chemotherapy
August '10 liver resection and HAI pump
7 months chemo FUDR HAI and Folfiri systemic
NED since August 2010
Last treatment April '11
HAI Pump removed Dec '15

brokenwings
Posts: 99
Joined: Mon Jan 07, 2019 1:50 am

Re: Any idea the cost for CRS/HIPEC at MSK if insurance not cover out of network?

Postby brokenwings » Thu Mar 28, 2019 3:44 am

tbt4snow wrote:Hi Pyro70,
I'm all set with the insurance concern. The trial specific for peri met is https://clinicaltrials.gov/ct2/show/NCT ... ell&rank=3 .
I raised my concern with the doctor and was told that they have not seen that the LUM015 affects any post-operative chemotherapy on Breast cancer patients.
Quote "We do not expect that the LUM015 will interfere with the effectiveness of the HIPEC treatment in any way, but we do not know for certain. Because the LUM015 is simply a dye, Dr. Cusack expects that the HIPEC treatment will be as effective as it would be if you did not have the LUM015 injection."
I am hopeful this technic is as effective to detect cancer cells in peritoneum as it is in breast cancer.


Best of luck! Keep us updated.

Hugs.
DX January 2019
Liberkulien Adenocarcinoma - Sigmoid colon
Met to right ovary or borderline cyst?
Obstruction during hospital stay.Temporary colostomy. Primary tumour still there.
Folfirinox: 6 cycles
CT Scan/PET Scan: ok for surgery
Surgery (CRS + HIPEC) scheduled for 04/29: not optimally resectable, surgery cancelled. Right ovary removed though...
2nd ptotocol: IP chemo (oxaliplatin) + IV chemo (Folfiri + Avastin).
06/25: 4th cycle
07/03: peritoneography
07/04: exploratory laparoscopy

tbt4snow
Posts: 21
Joined: Sat Oct 27, 2018 3:16 pm
Facebook Username: Tina tran

Re: Any idea the cost for CRS/HIPEC at MSK if insurance not cover out of network?

Postby tbt4snow » Mon Apr 29, 2019 8:25 am

Hi,
Just an update on my CRS/HIPEC. The procedure was 10 hours long. I was in hospital for a week. It's about 3 and half weeks out since the surgery and I'm still in a lots of pain.
My PCI at the outset of the procedure was 16 and at the completion of procedure was 1. There are .5 to 1mm fine discrete flat plaques involving the ileum that were unrespectable due to the extensive nature of the distribution of these plaques. This is not very encouraging. I'm seeing my surgeon today to see what the next step would be.
Best of luck for brokenwings. Hope all go well for you today.
DX: CC stage 4/w ovaries & omentum mets in 12/17 49/F
High grade pT3N1bM1b sigmoid Adenocarcinoma colon
MSS-h TMB=16, NRAS-mutant
Lymph nodes: 1/2 left colic; 3/8 regional
12/2017: Exploratory laparotomy & resect of sigmoid & ovaries
Folfox/avastin 12 sessions from 1/8-6/18. 6/18 CEA 2.1
1/19: CT shows peri mets;
CEA: 12/18 5.1, 1/7/19 7.9; 1/15/19 9.1; 1/30/19: 10.6
4/3/2019 CRS/HIPEC after 4 Folfiry sessions...

User avatar
henry123
Posts: 188
Joined: Sun Oct 08, 2017 3:25 am

Re: Any idea the cost for CRS/HIPEC at MSK if insurance not cover out of network?

Postby henry123 » Tue May 07, 2019 5:25 pm

I had got an estimate of around U$150,000 from Dr. S and U$7,500 (just surgery) from Tata Memorial centre in India. But keep in mind that there are other costs involved too besides surgery.
I did not undergo HIPEC treatment as disease had spread to lungs too.
46yo M msi-high Lynch +ve
5/16 lap AR 14/21 L nodes +ve
T4N2M1
7/16 Capox 9 cyc
9/16 cea 2
1/17 550
PET CT mets in lung & peri
iri+ avast fail
3/17 10577
4/17 regro fail
5/17 cea 28800
5/17 CT inc in size of mes nodes ,onset of multi nodules in liver.
6/17 Opdivo start
7/17 26754
8/17 5623
9/17 497
10/17 52
11/17 12
CT all clear exc a nodule in Lung. liver norm
1/18 3.6
4/18 2.0
Aspirin start
6/18 1.5 CT clear
12/18 1.1 CT Clear NED
4/19 1.1
6/19 .9 CT clear
Vegan yoga juicing
Still on opdivo

brokenwings
Posts: 99
Joined: Mon Jan 07, 2019 1:50 am

Re: Any idea the cost for CRS/HIPEC at MSK if insurance not cover out of network?

Postby brokenwings » Fri May 10, 2019 10:25 am

tbt4snow wrote:Hi,
Just an update on my CRS/HIPEC. The procedure was 10 hours long. I was in hospital for a week. It's about 3 and half weeks out since the surgery and I'm still in a lots of pain.
My PCI at the outset of the procedure was 16 and at the completion of procedure was 1. There are .5 to 1mm fine discrete flat plaques involving the ileum that were unrespectable due to the extensive nature of the distribution of these plaques. This is not very encouraging. I'm seeing my surgeon today to see what the next step would be.
Best of luck for brokenwings. Hope all go well for you today.


Hi there,

Thank you for keeping me in your thoughts. I'm glad you had CRS/HIPEC. Unfortunately I wasn't that lucky. When my surgeon opened me up, he found a lot of mets on my right colon. Since my tumour is in my left colon, he should have done a total colectomy and even in that case, he might not have been able to take it all out. So now I have to go back to systemic chemo + intraperitoneal chemo (clinical trial) to try to shrink everything... It's my last chance for becoming surgical...

I've just read that your TMB is 16, aren't you interested in immunotherapy?

Hugs,

Paola
DX January 2019
Liberkulien Adenocarcinoma - Sigmoid colon
Met to right ovary or borderline cyst?
Obstruction during hospital stay.Temporary colostomy. Primary tumour still there.
Folfirinox: 6 cycles
CT Scan/PET Scan: ok for surgery
Surgery (CRS + HIPEC) scheduled for 04/29: not optimally resectable, surgery cancelled. Right ovary removed though...
2nd ptotocol: IP chemo (oxaliplatin) + IV chemo (Folfiri + Avastin).
06/25: 4th cycle
07/03: peritoneography
07/04: exploratory laparoscopy


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