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Warts - when is a biopsy necesary

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Warts - when is a biopsy necesary

Old 03-31-2017, 06:19 AM
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Default Warts - when is a biopsy necesary

I know there are several physicians on this site and want to get another professional opinion.

My son had 2 warts removed yesterday (cut off). One located on his right forearm and the other on the index finger of his right hand. I looked at the billing chart when I got home and noticed they are sending both the warts out for pathology. Is this a bit extreme? The PA didn't mention anything about this during our visit and didn't feel a follow up visit was needed. He also didn't inspect any other part of his arm or body for any unusual skin conditions.

They already billed me the full (non-insurance) amount and not the BCBS (I do have) negotiated amount.

I spoke with the billing department and was informed they send everything out for biopsy (including skin tags...???).

Am I over-reacting to this or is this a non-ethical way to squeeze more money out of a patient?
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Old 03-31-2017, 06:28 AM
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If they didn't tell you and give you the option I'd not pay it. It is your call always not just their hidden policy. Dispute and find a different doctors office.
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Old 03-31-2017, 06:36 AM
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The dermatologist that doesn't send those samples out for testing is playing with fire. He or she are liable to be sued if a cancer were to ever develop anywhere in the general area of that wart.

Thank the US court system, and the sense of entitlement that most folks have that anything bad that happens must be someone else's fault. It would not surprise me if his medical malpractice insurer insists that he send out to lab any flesh removed.

I had a large wart removed recently, it ended up with 3 different bills from the labs that weren't covered by my insurance totaling about $150. It is what it is.
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Old 03-31-2017, 08:07 AM
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I had an uncle that died from malignant melanoma after having some 'warts' removed by a family doctor that were not biopsied. Turns out that if they had been biopsied it would have been caught early enough to treat. My family sued the doctor and settled for having the doctor give up his license.
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Old 03-31-2017, 08:10 AM
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Originally Posted by Onewolf View Post
I had an uncle that died from malignant melanoma after having some 'warts' removed by a family doctor that were not biopsied. Turns out that if they had been biopsied it would have been caught early enough to treat. My family sued the doctor and settled for having the doctor give up his license.
there's the answer
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Old 03-31-2017, 08:12 AM
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I doubt you will get any physicians to question the automatic sending of these for biopsy. I went to the dermatologist to get a wart removed from my finger and he went over my whole torso slicing off this and that (small moles, a skin tag). The lab bill was over $400 to get them all tested.
The worse thing was the finger wart came back. I kept it a few more years, then tried the apple cider vinegar method, which when done properly worked faster, with less pain and less scarring than anything I've seen done by the dermatologist. I've since used it for skin tags and small moles too. Unless something pops up that looks funky this will be my approach, and costs less than $5.
Disclaimer: I am not a home remedy kook.
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Old 03-31-2017, 08:18 AM
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I cut my own wart off with a fishing knife. Maybe I should have sent it in for testing.
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Old 03-31-2017, 08:43 AM
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Originally Posted by fishingfun View Post
I cut my own wart off with a fishing knife. Maybe I should have sent it in for testing.
Should have used for bait to see what you caught.

what is the apple cider vinegar method?
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Old 03-31-2017, 08:51 AM
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I've had a couple frozen off, plus I have cut them out myself, and also used dry ice to burn them off. That probably hurt the most. None were biopsied.

Still - any provider needs to let the patient know what the process is and what is entailed.
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Old 03-31-2017, 09:09 AM
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Originally Posted by jeremyj View Post
I know there are several physicians on this site and want to get another professional opinion.

My son had 2 warts removed yesterday (cut off). One located on his right forearm and the other on the index finger of his right hand. I looked at the billing chart when I got home and noticed they are sending both the warts out for pathology. Is this a bit extreme? The PA didn't mention anything about this during our visit and didn't feel a follow up visit was needed. He also didn't inspect any other part of his arm or body for any unusual skin conditions.

They already billed me the full (non-insurance) amount and not the BCBS (I do have) negotiated amount.

I spoke with the billing department and was informed they send everything out for biopsy (including skin tags...???).

Am I over-reacting to this or is this a non-ethical way to squeeze more money out of a patient?
Somewhere there should be a real physician involved. Take your concern about the communication issues directly to the physician. Not the PA. Not the billing clerk. The PA could have told you. Tell them your issue. Insist the physician call you directly. You should have been advised as to the billing and the pathology specimen. The fact that the billing clerk is correct shouldn't make your concerns go away.

The way I see it, if you take money from a patient, you now have them as your boss. You are obliged to hear their concerns. Agree or disagree, you "owe" them a hearing.

Every specimen removed from a patient should be sent to a pathologist. Including foreign bodies, splinters, tissue, serum, sputum, etc. To not do so will certainly be viewed as deviation from standard of care. (AKA lawsuit) The office does not receive any $$ from the pathologist. That is a separate service. If they get a kickback, that's unethical.

Lastly, if a physician takes a specimen, they are obliged to call you with the pathology result. You are paying for the information. The information is yours. Even if it's normal, or in you kid's case Verucca vulgaris. (aka wart) If you don't hear from them, call them. Only you can be responsible for your health. Corporate medicine (PA'a, hospital owned clinics and practices et al) don't care about you. Only you can care about you.
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Old 03-31-2017, 09:28 AM
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Pretty sure when they say to get a second opinion they don't mean from the internet...
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Old 03-31-2017, 09:33 AM
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If it were me I would want the biopsy done especially if it was for one of my children. Slim possibility is more than zero.
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Old 03-31-2017, 09:41 AM
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Originally Posted by jeremyj View Post

They already billed me the full (non-insurance) amount and not the BCBS (I do have) negotiated amount.
As a side issue...that's BS!. If they are in network they should verify your patient responsibility amount with BCBS. Even if all of this is applied to your deductible, they should only collect the amount allowed by their contract with BCBS. Also, their contract with BCBS requires them to use labs and pathologists that are in network, so you get the discounted in network rates with those providers, too...so don't let them tell you some non network pathologist is "who we always use"
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Old 03-31-2017, 10:22 AM
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I seem to remember a Dr telling me that any time a piece of tissue is removed during a procedure it must be sent to pathology. Also remember hearing that the pathologist must report any malignancy within 30 days. Hopefully a dr will weigh in on the veracity of this but it seems logical if the well being of the patient is the ultimate goal.
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Old 03-31-2017, 10:56 AM
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Originally Posted by 99yam40 View Post

what is the apple cider vinegar method?
Clean the wart with alcohol. Using a small piece of cotton the size of the wart (e.g., the head off of a Q-Tip), soak the cotton in apple cider vinegar and place over the wart. Cover with a band-aid, then (important) with any type surgical tape to make sure it is airtight and the vinegar does not evaporate. You can do this once a day (or more) and depending on the size of the wart it should be gone in 7-10 days. When the wart is gone and/or after you have removed the last of the dead wart tissue, use the ACV for one more day. I then use hydrogen peroxide on it for a couple of days to make sure any residual bacteria from the wart is dead. Then use anti-bac ointment to heal, which happens much more quickly than when the doctor uses the freeze method.

I repeated the ACV process overnight and just covered it with a band-aid during the day. The first two nights, take Advil or something before going to sleep because there is some stinging, but not nearly the pain (over a week) I had when the doctor tried to freeze the wart on the first try, and that method failed.
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Old 03-31-2017, 06:01 PM
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Originally Posted by Hops143 View Post
Pretty sure when they say to get a second opinion they don't mean from the internet...

If that's directed at me, I'm not sure what your point is. I'm not asking for a second opinion.


Thank you everyone, especially dssmith, for your responses. I spoke with the PA who stated it is standard procedure for their practice to do this (including skin tags). I explained my issue is with the lack of communication. We came to an agreement which I am happy with. Water under the bridge.
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Old 03-31-2017, 06:52 PM
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Originally Posted by blaineC View Post
Clean the wart with alcohol. Using a small piece of cotton the size of the wart (e.g., the head off of a Q-Tip), soak the cotton in apple cider vinegar and place over the wart. Cover with a band-aid, then (important) with any type surgical tape to make sure it is airtight and the vinegar does not evaporate. You can do this once a day (or more) and depending on the size of the wart it should be gone in 7-10 days. When the wart is gone and/or after you have removed the last of the dead wart tissue, use the ACV for one more day. I then use hydrogen peroxide on it for a couple of days to make sure any residual bacteria from the wart is dead. Then use anti-bac ointment to heal, which happens much more quickly than when the doctor uses the freeze method.

I repeated the ACV process overnight and just covered it with a band-aid during the day. The first two nights, take Advil or something before going to sleep because there is some stinging, but not nearly the pain (over a week) I had when the doctor tried to freeze the wart on the first try, and that method failed.
When I was young we would put duct tape over the wart leave it on for a week and they would disappear. Something about not getting any air too it.
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Old 04-01-2017, 07:06 AM
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Originally Posted by yammi250 View Post
I seem to remember a Dr telling me that any time a piece of tissue is removed during a procedure it must be sent to pathology. Also remember hearing that the pathologist must report any malignancy within 30 days. Hopefully a dr will weigh in on the veracity of this but it seems logical if the well being of the patient is the ultimate goal.
First part false, second part .report to whom? They better be telling the patients doctor as soon as they diagnose cancer....
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Old 04-02-2017, 07:41 PM
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I got a bill for testing on sons ingrown toenail after they cut it out.
Refused to pay. They never said anything about testing .
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