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Posted 1/3/2010 2:15 PM (GMT -5)
This topic was also discussed as part of another thread but is worth a seperate thread.

I have good insurance. I think my total cost will depend on how they do the deductible.

If I include the consultations, biopsy, pre-op and other tests, it will probably be under $1000.

If my deductible had been met, it would probably be about $300.

Mel

Posted 1/3/2010 2:20 PM (GMT -5)
Mel, that's pretty good. Most of us here in the US with decent health insurances seem to make out pretty well, myself included. That takes aways some of the sting we deal with in our PC journeys. Hate to go broke for the rest of my life on top of dealing with all this.

David in SC
Posted 1/3/2010 2:49 PM (GMT -5)
Gentlemen,

It seems that this thread is moving away from the intended discussion of Insurance and costs.

Mel, because of my wife's health issues throughout the year we had met the deductibles and out of pockets for 2009. My total cost for the trip to HF was $136.29. That included everything.

As to the Centers of Excellence; my wife was given a list that read like the who's who of facilities for her stem cell transplant. We selected MDA Houston and were reimbursed the entire amount we spent for the 14 week stay out there. Most companies have a lifetime cap, ours is 10k.

Sonny
Posted 1/3/2010 2:57 PM (GMT -5)
Ohio,

In that case maybe a more meaningful thread would be "How to fight PCa WITHOUT insurance".

You seem to have plenty of knowledge on that. There may be others that have been in this situation that can offer their experiences.

Sonny
Posted 1/3/2010 3:14 PM (GMT -5)

Sonny:

Nicely put. I feel very sorry for anyone with modest means fighting this disease without health insurance, despite Ohio's protestations.

But that would be an interesting thread in itself.

Mel

Posted 1/3/2010 3:26 PM (GMT -5)
Mel, I was so close to being in that situatiion. I was laid off in July 2008, company was too small to have to offer COBRA on my Blue Cross. SC law said the company had to offer me what I had for six months ,but totally at my own expense at what would have been COBRA rates. My ex-boss was very generous, and paid out of his pocket the entire 6 months. That took me through my PC dx, and the open Surgery and Hospitalation.

I am not foolish, I have had very good care with doctors, hospitals, specialists, tests, corrective surgeries, etc, but I am very aware its mostly because I was properly insured.

My wife's employer had "open enrollment" precisesly at the time my six month reprieve had ended ,a miracle. So I have been on hers since Jan 2009, and that took me through all the rest of my journey including the SRT recently, with no penalties for pre-existing conditions.

I feel incredibly lucky and thankful for my good fortune in that area.

David in SC
Posted 1/3/2010 3:39 PM (GMT -5)
My own experience is with individual insurance, high-deductible paired with a Health Savings Account. Picked up my insurance through ehealthinsurance.com.

As a small business owner, this was essentially the only option open to me. Thank goodness it was. My annual premiums plus deductible equaled about $10k (max), after which all expense is covered. And the side benefit? An annual physical is covered at 100%, without which the PCa would not have been detected. And without the coverage, I am such a cheap SOB that I'd never have paid for one myself. shakehead

Of course, now I'm at the mercy of my insurer, who has boosted my premium for 2010 by 25%. But I'm alive, fortunately able to pay the increased premiums, and doing well with my recovery.
Posted 1/3/2010 3:52 PM (GMT -5)
MaxBuck, welcome to HW Prostate Cancer, glad you found us and appreciate your post on the subject. I am so glad you took that physical, many men don't or won't or can't. Considering the cost of surgeries, radiation, hospitalation, etc, even with your type of insurance it had to be a big help in paying the bulk of your expenses.

Perhaps you can post about your PC journey.

David in SC
Posted 1/3/2010 3:53 PM (GMT -5)
Being 66, my treatment was covered by Medicare.  Less than $100 out of pocket so far.  IMHO Medicare is the best thing the US government has ever done.  Too bad a "public option" is off the table in our country, so people wouldn't have to worry about the expense of cancer treatment, arguing with insurance "adjusters", or losing future insurance eligibilty.  Seems to me insurance companies have already stepped in between patients and their doctors big time (ask any doctor), so I don't know why government as payer is anathema.   "Prior medical condition" is a unique American nightmare that no one should have to face.

Don't mean to vent, but I have a 57 year old relative who has been treated for brain cancer for two years.  He could no longer work, so when he left employment, he had to pay his insurance via COBRA.  Well, COBRA eligibility runs out this month, and there is no other way he can get insurance.  I don't understand why such things are acceptable in America.

NewsPaper Lover

 

Age 66

PSA:  6.0  on 07/31/09 having risen from 4.2 on 12/02/08.  Free PSA 23.5%.Other PSA History: 4.3 on 05/01/08; 3.3 on 11/15/07; 3.1 on 05/20/07; 4.0 on 11/30/06; 3.40 on 09/01/05.

 

Biopsy:  09/04/09  13 snips;  two positive.  Right Mid  4+3 = 7 and 15% of the total volume.   Right Lateral Mid 4+3 = 7 and 20% of the total volume.

 

DaVinci robotic surgery:  11/04/09.  Post surgery pathology:  margins clean, no invasion of seminal vessels, no upgrade of the Gleason scores, no evidence of cancer outside the prostate capsule.  No incontinence.

 

Posted 1/3/2010 4:02 PM (GMT -5)
I agree, NewspaperLover, the term "prior medical condition" can be a literal death sentence to some people. I was hoping for a "public" option too to stay on the table, its difficult when you don't have or have been denied health insurance, and you aren't old enough to qualify for medicare. Its a terrible black hole that no one should have to deal with.
Posted 1/3/2010 4:05 PM (GMT -5)

David:

You bring up another excellent point. For many of us, one of the many benefits of health insurance is the annual physical. I suspect without insurance I might have skimped more than a little on my annual physicals. My PC was dx. as an outgrowth of a rising PSA, discovered via my annual physical exam.

I can only feel terribly sorry for those roughly 50 million folks without health insurance. We already have friends, in fact two hard-working couples, where the husband got laid off and now they are sans insurance. In one case, the guy ended up in the hospital with chest pains. They ended up doing an angiogram, angioplasty, and inserted a few stents. He is recovering well, but will probably have a heart attack when he gets the bill. They are worried about having to sell their house.

I am very disappointed to see the public option off the table, but I hope the bill we end up with will forestall some of these horror stories.

Mel

Posted 1/3/2010 4:18 PM (GMT -5)
Mel, I agree, I did start annual physicals for myself at age 50, but only because I was in a good insurance siutation. Frightens me to think if I hadn't, with a raging Gleason 7 and fast PSA velocity going on at dx.

Without the insurance, I probably would never have had the first PSA done, but then again, I am married to a wonderful nagging nurse for 36 years, and not sure how long she would have let me got away with it. lol.

I am glad that at least health care is on the front burner, for once, hope something good comes out of the reconciliation of the two bills.

David in SC
Posted 1/3/2010 4:58 PM (GMT -5)
Since there's some discussion here about the desirability of federal government involvement in healthcare/insurance, I'd like to offer this: I might join (some of) you in being in favor of such involvement if Congress were able to put forth a statement of objectives for what they would like the involvement to accomplish. In other words, what are our priorities? And how will federal intervention help to solve the problems posed by lack of such involvement today?

I'm an engineer, and I'm all too familiar with how projects turn out when a concise project objectives statement is never developed: too much gets spent, most of which expenditure is either wasted or overblown in answering questions that nobody really asked. Unless and until Congress articulates what, exactly, its health-care plan is intended to accomplish, I cannot support their efforts.

We all want to be compassionate, but the federal government needs to be much better at managing our resources that we agree to allocate to it.
Posted 1/3/2010 4:59 PM (GMT -5)
OHIP -- PSA tests - as part of annual physical in Canada cost the patient $30.00 at the lab (money up front) - but if you are in a risk group - as determined by your GP doctor ( my partner is diabetic so his was free). My first PSA in 2009 cost me $30.00 - but the followup since I was at risk - was free.

NOTE: from what I read at the Canadian Cancer website (to paraphrase them)- re: PSA and prostate cancer - PSA's are of little benefit since PC is such a slow disease and men are more apt to die of something else... and all it causes is unnecessary worry and distress... ... there is a higher rate of cardiac arrest with men who have had PSA's....

I am glad I read that after my second PSA !
hugs
BRONSON
..............
Posted 1/3/2010 5:41 PM (GMT -5)
Hey Bronson,

I had to pay for my pre-dx PSA tests out of pocket, too. My PSA went from 5.3 to 7.3 in about 6 months. As a small biz owner, I didn't have the extended coverage many have here in Canada working for larger companies, those on social assistance or those working for the gov't...where that would have been covered.

IMHO, I disagree with the Canadian Cancer Society's stance. If I had waited another year or two, I wonder what my PSA would have been and my velocity. But, that's just me. I paid it myself.

All the best,

Mike
Posted 1/3/2010 6:29 PM (GMT -5)
And, Mike, my friend, I am so glad you did. Your situation could have been entirely different in a bad way if there had been much of a delay in your detection and treatment.

David in SC
Posted 1/3/2010 7:22 PM (GMT -5)
newpaperlover has a great point. I'm Medicare eligible but I also had Medicare Supplement insurance at a cost of $130/month. I didn't have to pay a penny for my entire PCa journey. Medicare is a great insurance for seniors and should be offered to everyone. Now that I have a pre-existing condition, my monthly cost has gone up to $190/month.
Posted 1/3/2010 7:29 PM (GMT -5)
Like David (Purgatory), we too are blessed with excellent health insurance. Out of pocket cost for John's surgery was $250 for the hospital and surgery (the total bill is something close to $60K for 48 hours in hospital). There's no cost to us for his PSA tests; there's a $25 co-pay each time he sees the uro/surgeon (about once every 6 months). As I've said, we are most fortunate to have excellent coverage. BTW: this coverage is not free - a substantial amount is deducted from my monthly pension to cover both of us but it's a bargain considering what others have to pay for lesser coverage.

I agree that a separate thread about dealing with PCa if you have no insurance would be an excellent one since there are many who are in just such a situation.

In answer to the question about how many men were diagnosed early because their wife pushed them: that was not the case with us. John has always been excellent about keeping up with his annual appointments. What saved him was the fact this regular MD has been charting his PSA results for 10 or more years and pushed him twice to go see a urologist - the first biopsy was negative, the second one 4 years later was not. Good doctors can be found.
Posted 1/3/2010 7:43 PM (GMT -5)

Thanks David, that 2nd PSA test with a significant rise led to a biopsy...and treatment.

As far as other costs, I had to pay out of pocket for a semi-private room (dual occupancy). That was a personal choice as I was sure I wanted some extra privacy and quiet. That was about $600 for 2 nights. Also had to pay for the pneumatic leg hosiery as it was custom. That was another $120.00, I believe. I haven't got a full list in front of me but, I would guess the whole thing was about $1500 out of pocket.

Mike

Posted 1/3/2010 7:53 PM (GMT -5)
EdC - even with the increase you mentioned, that is a bargain in the world of health insurance, glad you got that to depend on.

Sephie, I would have to actually give the credit to my long term GP (13 yrs I believe), he keeps a good eye on me and knows my ailments past and present well.

Mike, even your extra fees aren't too bad. Both the major hospital systems where I live have private rooms only, glad, in that frame of mind post immediate surgery, not sure I would have wanted any room mates.

David in SC
Posted 1/4/2010 6:26 AM (GMT -5)
I know I'm far from the only retired military guy here, and having Tricare Prime for my insurance was for me, a blessing. My total bill for surgery and a private room was over 35k, my out of pocket was $25. The annual premium cost is $230---annually, not monthly. I have it deducted directly from my retirement check so I never even notice the payment. I only wish the short term disability insurance from work was as cheap :P

Ralph
Posted 1/4/2010 7:59 AM (GMT -5)
Ralph, that's an amazing low price per year. Good going.
Posted 1/4/2010 10:00 AM (GMT -5)

Purgatory said...
I agree, NewspaperLover, the term "prior medical condition" can be a literal death sentence to some people. I was hoping for a "public" option too to stay on the table, its difficult when you don't have or have been denied health insurance, and you aren't old enough to qualify for medicare. Its a terrible black hole that no one should have to deal with.

Thank Joe Lieberman for reneging on an early medicare buy in for those of us 55-65, Dave. Fortunately I have excellent insurance being a federal retiree but for others that was really tragic. Politics at its worse. The fact that substantial dollars in premiums go to Wall Street type bonuses and over a million dollars a day in media advertisement against health care reform is immoral IMHO. Imagine if those funds went to what the subscribers intended for it, to primarily go to actual medical costs. The rest of the industrialized world looks at us in disbelief letting a cartel decide who lives and dies according to profits. I'm all for free enterprise but this is absurd.

Post Edited (realziggy) : 1/4/2010 8:03:54 AM (GMT-7)

Posted 1/4/2010 11:58 AM (GMT -5)
I agree fully with you ziggy on your post. Too many black holes in the system, where the sick and innocent can disapear forever without hope. For such a wealthy and high tech country, its more than a crying shame.

David in SC
Posted 1/4/2010 12:30 PM (GMT -5)
For 2 PSA tests, biopsy 2nd opinion pre-surgery tests and DaVinci so far have been $85,809.93!!
Hubby's insurance paid 80% till $1500, decuctible met then 100% so our expenses have been $1574.10 if billers agree with insurance on amount.
Thank God for the insurance. It only covers him not myself or daughter. Good thing we were not the ones who got PCa just kidding :)
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