Like I said, most consultants answer the specific question from the outside pathologist. On the other hand, does every pathologist in general look at the grossing of all specimens? For example, do you think every pathologist looks at the margins and how they are inked on a lumpectomy. Of course not, the PA grosses it and you trust they did a good job. But, you are putting your name down saying the part they called a margin is actually a margin. We all have to trust others to a certain degree and trusting your hypothetical pathologist with 10 years experience and a fellow who sees around 400 prostate cases/week to call something benign seems logical to me. Remember, I am not talking about trusting someone else to make the primary diagnosis. The outside person already made the diagnosis. That is not why they're sending the case. I cant stress enough how important that is.
As far as billing, usually the referring group is billed. In Epsteins case, he has a contract with a large biopsy mill where he gives them a cut rate ($60-70 comes to mind), but is slightly higher for others.