The scenario: Gleason 3+3, PSA 4.4. 2 of 12 cancerous with the biopsy. A
good health insurance policy. Age: 64 1/2 , six months from Medicare.
Consult with the urologist and pre-registered with the hospital. No
recommendations to wait for Medicare. Scheduled for seed implants on 29
December 06. 3 1/2 hours at the hospital. Their bill: $46,000+, two
anethesists, urologist and radiation oncologist pushed the total bills to
$68,000+. Out of pocket: $5,000+. Now I find out Medicare would have paid
the entire hospital bill had I waited. I did not know as I am just becoming
familiar with registering for Medicare. Should I have been advised to wait?
I know. You can't put a price on the consequences of not having it done
right away. But I had been under the impression that my biopsy results
meant that I had a slowly progressive cancer.
I.P. Freely - 14 Feb 2007 21:42 GMT
> The scenario: Gleason 3+3, PSA 4.4. 2 of 12 cancerous with the biopsy. A
> good health insurance policy. Age: 64 1/2 , six months from Medicare.
[quoted text clipped - 8 lines]
> right away. But I had been under the impression that my biopsy results
> meant that I had a slowly progressive cancer.
Of COURSE you should have waited!
Unless, of course, it would have killed you.
The only way you'll ever *know* is if PC kills you anyway, at which
point you still won't really know whether your wait accelerated anything
or not.
So your gut is right: the answer is "who knows?".
Or you could drive yourself nuts doing days or weeks of research and
statistical analysis into a six-month delay, which would provide . . .
statistics.
Are you a statistic? If so, what side of the statistical curves would
your body have followed?
Fuhgheddaboutit. It's done. You did the best you could, and the cards
will fall where they may.
I.p.
James - 14 Feb 2007 23:48 GMT
> The scenario: Gleason 3+3, PSA 4.4. 2 of 12 cancerous with the biopsy. A
> good health insurance policy. Age: 64 1/2 , six months from Medicare.
[quoted text clipped - 8 lines]
> having it done right away. But I had been under the impression that my
> biopsy results meant that I had a slowly progressive cancer.
It is very unlikely that waiting 6 months would have made any difference in
your outcome.
I am a little surprised at your out of pocket expenses. Most "good"
insurance plans like Cigna and Aetna cap the maximum out of pocket to
between $1500 - $3000 per person, per year for In-Network providers. These
are PPO (preferred provider org) plans (not HMO's). A large percentage of
providers participate in the In-Network for plans offered by Cigna, Aetna,
and United PPO's. Out of Network caps are usually about $10,000. Was the
seed therapy considered out-of-network, or did you not even have a PPO plan?
One thing to remember is that even though the Insurance companies get
reduced rates from most providers, the US government gets even lower rates
for Medicare, so the doctors and hospital had no incentive to suggest that
you wait.
But more important, some on this newsgroup would like to know what your
experience was with the seed therapy. How was your recovery, urinary
continence, sexual potency, etc, after the treatment.
3Putt from South Carolina - 15 Feb 2007 03:12 GMT
>> The scenario: Gleason 3+3, PSA 4.4. 2 of 12 cancerous with the biopsy.
>> A good health insurance policy. Age: 64 1/2 , six months from Medicare.
[quoted text clipped - 29 lines]
> experience was with the seed therapy. How was your recovery, urinary
> continence, sexual potency, etc, after the treatment.
Would be interested in knowing what the monthly premiums are on these plans?
I had provided a few updates on my procedure/progress at the end of December
and early January. My insurance is under the Federal Employee Health
Benefits (FEHP) program and I only use their PPO. Max cap is $4000 out of
pocket per year. The additional $1000 is for MRI, sonogram, etc this
calendar year.
James - 15 Feb 2007 04:57 GMT
> Would be interested in knowing what the monthly premiums are on these
> plans? I had provided a few updates on my procedure/progress at the end of
> December and early January. My insurance is under the Federal Employee
> Health Benefits (FEHP) program and I only use their PPO. Max cap is $4000
> out of pocket per year. The additional $1000 is for MRI, sonogram, etc
> this calendar year.
I pay $75 per month for a Aetna PPO plan with $1500 max out of pocket. My
employer pays 80% of the actual cost, so the actual premium is $375 per
month for an individual. There is a another plan they offer which has $3000
max out of pocket (copays are higher, etc) that is about $40 per month to
the employee.
Alan Meyer - 15 Feb 2007 00:13 GMT
> The scenario: Gleason 3+3, PSA 4.4. 2 of 12 cancerous with the
> biopsy. A good health insurance policy. Age: 64 1/2 , six
[quoted text clipped - 11 lines]
> that my biopsy results meant that I had a slowly progressive
> cancer.
I'm not sure what you're asking 3Putt. Are you wondering how it
is that a 3.5 hour hospital stay generated a $68,000 bill? Are
you wondering why four doctors split $22,000 for less than half a
day's work? Are you wondering why no one advised you that you
would be socked for $5,000, or could avoid it by waiting? Or are
you perhaps wondering why our health care system pays for all
this if you are 65, but not if you are 64-1/2?
I wonder about all of that myself. But I guess it's all too
complicated for a simple fellow like me to understand.
I wish my Congressman would explain this to me.
Alan
Alan Meyer - 15 Feb 2007 00:31 GMT
> I'm not sure what you're asking 3Putt. Are you wondering how it
> is that a 3.5 hour hospital stay generated a $68,000 bill? Are
[quoted text clipped - 3 lines]
> you perhaps wondering why our health care system pays for all
> this if you are 65, but not if you are 64-1/2?
Incidentally, and just for reference, my son recently had a heart
procedure lasting several hours by two top heart surgeons at
Johns Hopkins Hospital. I met them and they were the real deal.
The principal surgeon had a PhD in electrical engineering from
MIT and an MD from Harvard. He was sharper than the proverbial
tack and the other guy was no slouch either.
My son too had anaesthesia, an operating room, the whole shtick,
plus an overnight stay at the hospital. His total bill (unless
there's more to come) was $17,000, of which his out of pocket is
$100. We thought the bill was pretty high, but that was before I
saw your $68,000 bill for comparison.
It's an amazing system we have.
Alan
Doug Taylor - 15 Feb 2007 01:00 GMT
>The scenario: Gleason 3+3, PSA 4.4. 2 of 12 cancerous with the biopsy. A
>good health insurance policy. Age: 64 1/2 , six months from Medicare.
[quoted text clipped - 8 lines]
>right away. But I had been under the impression that my biopsy results
>meant that I had a slowly progressive cancer.
You was robbed.
3Putt from South Carolina - 15 Feb 2007 03:14 GMT
>>The scenario: Gleason 3+3, PSA 4.4. 2 of 12 cancerous with the biopsy. A
>>good health insurance policy. Age: 64 1/2 , six months from Medicare.
[quoted text clipped - 13 lines]
>
> You was robbed.
You might be right. I think I took it up the ...
Alan Meyer - 15 Feb 2007 04:42 GMT
> You was robbed.
A much more concise and eloquent formulation of a proposition
that took me 50 times as many words to say.
Alan