You're right Buster, it's hard to understand the logic of medical billings. Comparing my costs to yours for Indiana IU: my billing was $24,838, all approved and paid by Medicare except for $674 which my secondary insurer Anthem paid entirely. Dr. Lingeman charged me the same as Dr. K, $4246, but Medicare approved and paid only $787.36, and Anthem paid the $157.47 for which I was theoretically responsible. I owed nothing. Both type of charges different from your situation. Did you have to pay some amount?
By the way, were you in the hospital more than one day? I only stayed one day.
By the way, were you in the hospital more than one day? I only stayed one day.
Hello Buster,
Ur HoLEP costed only about $5K!! The lowest i know. Will write about my experience when I have time.
Letting others know about the the true cost of HoLEP will help someone to negotiate with the hospital in case he has to pay out of pocket.
Ur HoLEP costed only about $5K!! The lowest i know. Will write about my experience when I have time.
Letting others know about the the true cost of HoLEP will help someone to negotiate with the hospital in case he has to pay out of pocket.
My stay was overnight. I had to pay some on my deductible but otherwise everything was paid for.
The Midwest is usually lower cost. My taxes are much lower than my brother’s in NY.
Contributor
149 posts
Regarding HoLEP costs:
At Vanderbilt (with Dr N. Miller) the total charges amounted to $31,787.76. I paid my deductible/maximum out of pocket and then the rest was all paid for by my Blue Cross insurance. The whole billing process was very efficient. I can't say enough good things about Vanderbilt & Dr Miller (PS: I have no relationship with either). In retrospect: Considering the benefits that I have gained by having the HoLEP procedure done, I would have paid cash for it if I had not had insurance.
Hello Phillip,
Glad to hear u are happy with your choice of Dr. Miller and HoLEP. I read her paper on HoLEP and she definitely is one of the best.
Any idea how much blue cross paid Vanderbilt? In my case, it was slightly over 8 thousands dollars.
Glad to hear u are happy with your choice of Dr. Miller and HoLEP. I read her paper on HoLEP and she definitely is one of the best.
Any idea how much blue cross paid Vanderbilt? In my case, it was slightly over 8 thousands dollars.
Contributor
149 posts
Looks like Blue Cross paid $29,039.27.
Where can I find the paper Dr Miller wrote? (Remember this site does not like links)
I am glad that u didn’t have to pay $29K out of ur pocket (use that money for charity?).
Dr. Miller’s paper :
ncbi.nlm.nih.gov/pmc/articles/PMC5085273/
Dr. Miller’s paper :
ncbi.nlm.nih.gov/pmc/articles/PMC5085273/
Happy New Years and good health to all!
I had HoLEP on 11/26/18 at the Thomas Jefferson University hospital by Dr. Ahkil Das and a followup visit with him on 11/21/18(4 weeks after holep).
This post is about my experience about the follow up visit.
I had been having severe constipation which required me to push hard during bowl movement. Pushing hard caused prostate wounds from HoLEP to bleed. But even had to push hard, by week 3, I had no more blood in the urine. However, penis still caused slight pain. My biggest complication were (and still are) nocturia or frequent urination during sleep and ultra bladder sensitivity . I had to get up from sleep every hour or so, also I had to urine several times to empty the bladder. I felt the pressure on the bladder if there was any residual urine.
During the first four weeks, I found that 2 colace(stool softener) tablets during dinner, and 2 ducalax tablets, one cap full miralax right before sleep solved my constipation problem. With that I did that I did not have to push hard. This reduced bleeding.
I do not have in continence. But almost sure have retrograde ejection and possibly reduced sensation as pointed out by Buster . Time will tell.
On the day of the following up, the nurse checked my urine speed and retention. I peed to a bucket which measured the urine speed. Since I was familiar with this, I was able to read the chart, it said Qmax=21cc/sec and average speed was 3cc/sec. the nurse used ultrasound to measure the retention which was 19cc, which was not zero but acceptable. I also did an urine test.
The meeting with Dr. Das was a bit not as informative as I had expected . He did not mention the Qmax and Retention results and gave the impression that he had not looked at the results. I had requested for a picture of the prostate/urethra before and after HoLEP. The picture showed that the urethra was blocked before HoLEP and the blockage was cleared after HoLEP.
I asked him the following questions listed below together with his answers. (I was expecting Dr. Das would discuss some of them with me. But he didn’t, I had to ask.)
Q1: Pathological result
And：no cancer
2) should I worry the average urine speed is only 3cc/sec which is terribly slow?
Ans： only Qmax is important (I agree because that tells the urine flow is unimpeded. 21cc/sec is a very good number. I found that the speed of my urine depends linearly on how much urine is in the bladder. I had seen stronger stream, thus my Qmax should be greater than 21cc/sec. the best Qmax after HoLEP I had read is 25cc/sec.)
3) during sleep, I Need many streams and long time to empty my bladder, also has hyper sensitive bladder due to retention, should I worry about bladder has lost its contract ability ?
Ans: tissue was removed by holep and the body was trying to adjust, it might take 3-6 months to heal. Kegel could help nocturia. (He didn’t seem to have answer for bladder ultra sensitivity. So I dropped the issue.)
4 )How to find out if there is scar formation?
Ans: only way is to to do a cystoscopy. Worry only if flow is impeded.
5) How do I know if internal sphincter is Working?
Ans: there is way to know, the only way to find out is to do a real-time video using urodynamic.
I had HoLEP on 11/26/18 at the Thomas Jefferson University hospital by Dr. Ahkil Das and a followup visit with him on 11/21/18(4 weeks after holep).
This post is about my experience about the follow up visit.
I had been having severe constipation which required me to push hard during bowl movement. Pushing hard caused prostate wounds from HoLEP to bleed. But even had to push hard, by week 3, I had no more blood in the urine. However, penis still caused slight pain. My biggest complication were (and still are) nocturia or frequent urination during sleep and ultra bladder sensitivity . I had to get up from sleep every hour or so, also I had to urine several times to empty the bladder. I felt the pressure on the bladder if there was any residual urine.
During the first four weeks, I found that 2 colace(stool softener) tablets during dinner, and 2 ducalax tablets, one cap full miralax right before sleep solved my constipation problem. With that I did that I did not have to push hard. This reduced bleeding.
I do not have in continence. But almost sure have retrograde ejection and possibly reduced sensation as pointed out by Buster . Time will tell.
On the day of the following up, the nurse checked my urine speed and retention. I peed to a bucket which measured the urine speed. Since I was familiar with this, I was able to read the chart, it said Qmax=21cc/sec and average speed was 3cc/sec. the nurse used ultrasound to measure the retention which was 19cc, which was not zero but acceptable. I also did an urine test.
The meeting with Dr. Das was a bit not as informative as I had expected . He did not mention the Qmax and Retention results and gave the impression that he had not looked at the results. I had requested for a picture of the prostate/urethra before and after HoLEP. The picture showed that the urethra was blocked before HoLEP and the blockage was cleared after HoLEP.
I asked him the following questions listed below together with his answers. (I was expecting Dr. Das would discuss some of them with me. But he didn’t, I had to ask.)
Q1: Pathological result
And：no cancer
2) should I worry the average urine speed is only 3cc/sec which is terribly slow?
Ans： only Qmax is important (I agree because that tells the urine flow is unimpeded. 21cc/sec is a very good number. I found that the speed of my urine depends linearly on how much urine is in the bladder. I had seen stronger stream, thus my Qmax should be greater than 21cc/sec. the best Qmax after HoLEP I had read is 25cc/sec.)
3) during sleep, I Need many streams and long time to empty my bladder, also has hyper sensitive bladder due to retention, should I worry about bladder has lost its contract ability ?
Ans: tissue was removed by holep and the body was trying to adjust, it might take 3-6 months to heal. Kegel could help nocturia. (He didn’t seem to have answer for bladder ultra sensitivity. So I dropped the issue.)
4 )How to find out if there is scar formation?
Ans: only way is to to do a cystoscopy. Worry only if flow is impeded.
5) How do I know if internal sphincter is Working?
Ans: there is way to know, the only way to find out is to do a real-time video using urodynamic.
Sorry to hear about the bleeding issue. I know constipation can be an issue after surgery. It is great to hear that you are continent. I assume that is due to small amount of bladder neck tissue that was removed. For whatever reason that is a big plus.
As for the nocturia I had a lot of that but I am at one or two times a night, about 3 hours apart.
It sounds like Dr. Das answered most of your questions. Your report is very informative as are your other posts.
As for the nocturia I had a lot of that but I am at one or two times a night, about 3 hours apart.
It sounds like Dr. Das answered most of your questions. Your report is very informative as are your other posts.
More on first follow up doctor office visit:
After holep, the first 5 days I had the catheter attached to me. From catheter removed to the first 4 weeks, I had a small amount of urine leak evident by slight wet on the underwear in front of the penis. Also a larger amount of urine would leaked out when I tried to force gas ( due to bloating) out of the stomach.
However, by week 5, both leakages were no longer there. I believe both were likely due to the external sphincter were slightly injured by HoLEP as I feel that it would take more than 5 weeks for the internal sphincter to heal. However, I don’t have any scientific proof.
After holep, the first 5 days I had the catheter attached to me. From catheter removed to the first 4 weeks, I had a small amount of urine leak evident by slight wet on the underwear in front of the penis. Also a larger amount of urine would leaked out when I tried to force gas ( due to bloating) out of the stomach.
However, by week 5, both leakages were no longer there. I believe both were likely due to the external sphincter were slightly injured by HoLEP as I feel that it would take more than 5 weeks for the internal sphincter to heal. However, I don’t have any scientific proof.
Hello Buster,
Do u recall how bad was ur nocturia right after HoLEP and how long did it take to reduce to 1-2 times a night?
Do u recall how bad was ur nocturia right after HoLEP and how long did it take to reduce to 1-2 times a night?
I looked back in my notes and could not find reference to the number of times I got up in the night. I was incontinent so I kept track of the number of wet pads that I went through.
Thanks for checking. Sorry, I forgot about the incontinence that made it difficult to keeep track of the number of time I had to get up.
More on follow up visit:
I also asked dr das what caused nocturia. He said because the body was relaxed during sleep.
But I thought differently, it might be due to one was tired.
I also asked dr das what caused nocturia. He said because the body was relaxed during sleep.
But I thought differently, it might be due to one was tired.