If you’re considering prostate artery embolization (PAE) for BPH – a medical term for prostate enlargement, you may be wondering about the cost. Since PAE is a minimally invasive procedure designed to relieve the urinary symptoms associated with BPH, it already incurs less cost than more invasive surgical procedures. Even better, it comes with a lower risk of side effects, eliminating the need for expensive hospital stays and costly follow-up care. This article delves deeper into the prostate embolization cost and explores areas where savings can be made. But first, let’s get started with an explanation of the PAE procedure.
PAE is an innovative treatment designed to reduce an enlarged prostate by limiting the blood supply in specific arteries ‘feeding’ the gland. Performed by interventional radiologists, the procedure involves injecting tiny embolic particles into specific arteries to reduce the blood flow using advanced imaging to guide them to their target. This effectively ‘starves’ the prostate causing it to shrink over time, relieving the pressure placed on the urethra and improving urinary function.
For many years, transurethral resection (TURP) has been the gold standard of treatment for BPH. However, this procedure comes with risks like excessive bleeding and erectile dysfunction. PAE, on the other hand, offers a less invasive procedure and relatively mild (temporary) side effects.
One study comparing the two procedures, concluded that PAE is a cost-effective strategy to treat BPH, resulting in comparable health benefits at a lower cost than that of TURP even when accounting for variations in costs and recurrence rates.
So now we know that PAE is typically cheaper than TURP and other surgical procedures, let’s get back to the crux of this article – Prostate Artery Embolization Cost.
The cost of PAE varies from one individual to another and can be influenced by several factors:
Location, location
The cost of medical procedures can vary enormously depending on the specific healthcare facility and its location. For example, prices in larger cities will always be elevated due to the higher costs of living.
Type of healthcare facility
On average, PAE procedures performed in outpatient labs have proved to be considerably lower than those in a hospital setting since no general or spinal anesthesia, no theatre room, or overnight stay is required.
An article published in 2024 comparing the costs of PAE in a hospital setting versus an outpatient lab showed the total costs for a hospital-based setting to be slightly higher ($3,858.28 vs. $3,642.67). Furthermore, extended procedural durations in hospital settings and variations in reimbursement structures may make outpatient facilities a more cost-effective choice for PAE.
Insurance coverage
Insurance coverage plays a large role in determining out-of-pocket expenses for medical procedures. Medicare, the largest public insurer in the United States, covers 80% of the cost of outpatient procedures like PAE. If combined with Medigap supplemental insurance, which follows Medicare guidelines, the remaining 20% of the procedure cost is typically covered, minimizing the patient's financial contribution.
Some private insurances, particularly those covering prostate surgeries, also cover PAE. However, it should be noted that coverage details differ widely among providers and some plans require prior authorization before approving the procedure. Always read the small print and contact your insurance provider to verify that PAE is included in your plan.
Additional medical services
Pre-procedure consultations, imaging analyses, and post-procedure follow-ups can add to the overall cost.
Expertise of the physician
More experienced interventional radiologists may charge higher fees but with this comes lower risk of complications and improved outcomes.
To manage the financial aspects of PAE effectively, consider the following steps:
Speak to your insurance provider: Before scheduling the procedure, get in touch with your insurance company to ascertain coverage details, including any necessary pre-authorizations and potential out-of-pocket costs.
Consider different healthcare settings: Ask your healthcare provider whether you can have the procedure performed in an outpatient lab to try and reduce costs.
Review Medicare options: If you're eligible for Medicare, learn how it applies to PAE and consider supplemental insurance plans to cover additional costs (Fair Square Medicare).
Ask about payment plans: Some healthcare facilities offer payment plans or financial options to help manage costs. Be sure to speak to the billing department to find out more.
Compare costs across providers: Prices can vary between providers and facilities so always arm yourself with multiple price estimates to make an informed decision.
Look for self-pay discounts: Some providers offer patients discounts when they pay out-of-pocket rather than going through insurance.
Check for employer or veteran benefits: If you have employer-provided insurance or veteran benefits, check to see if PAE is covered under those plans.
Prostate Artery Embolization is a game-changer for men experiencing urinary symptoms due to an enlarged prostate. Understanding the associated costs and ways in which you can make savings, is essential in the decision-making process. By proactively engaging with insurance providers, exploring different healthcare settings, and discussing financial options with your healthcare team, you can make informed choices that meet your health needs and financial situation.
If you're considering PAE and want to explore your options further, contact Mint STL today. Our experienced team is dedicated to providing personalized care and guiding you through every step of the process to help you get your life back on track. We operate on an out-patient basis with most patients able to return home the same day to complete their recovery. Call us today or request an appointment
