Here comes some noise ~ Medicare coverage for Proton Therapy challenged

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Tony Crispino
Veteran Member

Date Joined Dec 2006
Total Posts : 8128
   Posted 10/16/2008 12:01 AM (GMT -6)   
OK then,
Blue Cross is asking the Centers for Medicaid and Medicare to not cover Proton Beam Therapy.  I have a link below for that story, courtesy of my friend, Mike Scott.    I love a good debate so I'll stay tuned on this one.  On one hand we have a great therapy, and expensive therapy, and on the other? The government.
Here is the link on this one:
Gentlemen, start your engines!
Age 46 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007 @ The City of Hope
Post-Op Pathology: Gleason 4+3=7, positive margins, Extra Prostatic Extension (EPE)
Bilateral seminal vesicle invasion (SVI); Stage pT3b, N0, Mx
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (September 17 '08): <0.1 ~ Undetectable!
You can visit my Journey at:

Veteran Member

Date Joined Jul 2008
Total Posts : 966
   Posted 10/16/2008 8:18 AM (GMT -6)   
Oh boy Tony....this will certainly be debated with much heated arguement on both sides. Bad part is that this subject sooner or later will turn political with the election and health care debates. I hate that goverment will be involved sooner than later.
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal-Gland 38 cc
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral (Perineural Invasion present at base)
Gleason (3+3) 6  Stage T1C
August 23 - Bone Scan - Hips, Spine and ribs marked uptake - X-Ray showed clear -Hooray
Sept 9 2nd DRE - questionable - TRUS...shadow in base - Gland now 41 cc
Robotic Surgery Sept 18, 2008
Pathology October 1,2008
Gleason 7 (4+3) Staged pT2c NO MX
Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
14 tumors in prostate - largest being 6 cm 

Regular Member

Date Joined Sep 2008
Total Posts : 54
   Posted 10/16/2008 9:27 AM (GMT -6)   

Hey Tony!

Now we will have a good thread here.Hopefully most of you have excellent health coverage through your job. Unfortunately many of us have lost health benefits even though we have paid for insurance for our whole life.The insurance companies were able to rewrite the laws in 2005 to effectively end coverage for erectile dysfunction.

If you suffer from ED in Indiana - for whatever reason your coverage has been dropped from any individual policy. This also includes the state mandated high risk pool. We are still searching all small group policies to see if there are any that cover ED - so far it doesn't look promising.

If and when I need a revision for my implant - which I will. There will be no coverage. I have an Anthem plan (Blue Cross) - the new policy will not cover any expense dealing with the treatment of ED (for me the penile implant). Even if I go to a PPO physician and hospital, I will not be afforded the discount rate insured patients receive. I will pay the ‘retail’ rate—that in some cases in 2 1/2 times the insured discount rate. Scary - yes. On top of that, if I am treated for ED, and have a complication - say a heart attack during surgery, or other condition caused by the ED treatment. That also will not be covered according to Anthem. I have had many conversations with the Indiana Department of Insurance - and they agree. I could easily be bankrupt if things don’t go well. If things work out great - I’ll only be out 30,000 or so. Comforting, isn’t it? We are the only industrialized country in the world where an individual can be bankrupted my the medical system. All the technology and medical resources that America has to offer is a wonderful thing. It’s just a shame it is out of reach of so many of our citizens.

1979: Organic impotence at age 25 from drug reaction to coumadin.
1979 Half shunt & vena cava clip emergency surgery - 4 weeks in Ohio State Medical Center
1981 IPP implanted - 3 1/2 weeks Baylor U. Houston by F. Brantley Scott
1981 IPP replaced - 10 days Baylor U. Houston by F. Brantley Scott
1985 IPP replaced IPP due to implant shift - 1 week Mayo Clinic by William Furlow
1985 IPP replaced, penile degloving to correct scarring, shortening and cylinder contracture. Suspensatory Ligament procedure - 2 1/2 weeks Mayo Clinic by William Furlow
1989 IPP replaced, repair of Tunica albuginea around corpora cavernosa . Degloving to relive penile shortening - 10 days Baylor U. Houston by F. Brantley Scott.
2000 IPP removed due to fluid loss and possible infection - 6 days Cleveland Clinic by Dr. Karl Montague
2000 IPP replaced - 4 days Cleveland Clinic by Dr. Karl Montague.
2002 IPP replaced, penile degloving to correct penile shortening due to IPP removal for 2 months. Repair of Tunica albuginea around corpora cavernosa - 3 days U of Washington, Seattle Dr. Richard Berger.

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