Insurance in General

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lewvino
Regular Member


Date Joined Jul 2009
Total Posts : 384
   Posted 8/6/2009 11:02 AM (GMT -6)   
My surgery is next week. As part of my Health Insurance Plan they offer a Free Service for Patient questions, follow up care  general questions etc. Just about 1 hour ago while talking with the man and answering numerous questions he literally asked: "Are they sure you have prostate cancer?" I was thinking. gee..what an idiot...I'm going to go have surgery just for the fun of it? I told him YES THEY ARE SURE I HAVE CANCER That was what the biopsy samples were all about!
 
Larry
Age at diagnosis 54, PSA 5.1
Father treated for Prostate Cancer in 1997 with Proton
Biopsy 04/08 12 cores, 5 positive
Gleason 3 Cores at 4+3=7
              2 Cores at 3+4=7
Perineural Invasion Noted on biopsy

Robotic surgery Scheduled 08/12/09 at Vanderbilt, Nashville TN. 


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 8/6/2009 11:24 AM (GMT -6)   
I dunno...I am always suspicous of those Health Care Consultants. My insurance company actually paid for a consultant even after I told the consultant I wasn't about to share my medical history with anyone I don't know along with any other personal information. Those consultants try to advise what procedures to use, what doctor to use etc., all for the benefit of reducing costs to the insurance company. I maybe wrong about that, but that is what my take was.

Personally...I wouldn't talk to them. What you do with your health care is your business and should remain between you and the doctor.
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month Apr 2009 .06
                   9 month Jul  2009 .08


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 8/6/2009 11:40 AM (GMT -6)   
BC/BS-TN assigned a Medical Care Nurse Rep. to me when I had mine. I was reluctant to say yes, but after the insurance refused to pay for the Surgeon and hospital stay(strangely they paid for the aneastelogist (SP), surgical suite and nursing care on the floor for 2 days), due to my being kept 5 hours longer than had been pre-approved, she cut through all the crap and got it fixed pronto. I worked with her for the 8 weeks that I was under the post-surgery plan and she was excellent. She even tried to get an override on the 'no ED drugs for recovery' policy BC/BS had. Never made any suggestions of altering my care plan, worked for me, like having my personal health advocate. This may not be the case in all cases or all the time, but really helped me get almost $17,000 in refused payments fixed.
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP 110gms.- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
22 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix 30/1/20-.10ml 2X week continues
PSA's: .04 each test since surgery

Post Edited (James C.) : 8/6/2009 11:44:22 AM (GMT-6)


lewvino
Regular Member


Date Joined Jul 2009
Total Posts : 384
   Posted 8/6/2009 11:52 AM (GMT -6)   
James,
This is BCBS/TN. I live near Chattanooga. Even though the guy asked such a question he is actually helping me. My wife works at a small local hospital which is self insured with BCBS. They Need a letter from my Robot Dr. saying that I am having robotic surgery, Then that is faxed to the hospital my wife works at which will then send a letter stating they do not offer robotic surgery. They actually have a robot on order but I would not want to be on the learning curve once they get the robot!
 
With out the letter I would have to pay an extra 8,000 since I'm going 'out of the hospital' we are insured at.
 
 
Larry
Age at diagnosis 54, PSA 5.1
Father treated for Prostate Cancer in 1997 with Proton
Biopsy 04/08 12 cores, 5 positive
Gleason 3 Cores at 4+3=7
              2 Cores at 3+4=7
Perineural Invasion Noted on biopsy

Robotic surgery Scheduled 08/12/09 at Vanderbilt, Nashville TN. 


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 8/6/2009 12:21 PM (GMT -6)   
Larry, I considered going to Vandy and Dr. Smith for RRP, but decided to stay local (Kingsport) and have open with a very experienced surgeon here. The logistics were a little awkward at the time. I suppose what I got for an Advocate is the same as you, she took a long questionaire from me over the phone, then all our contact was by phone after that.
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP 110gms.- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
22 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix 30/1/20-.10ml 2X week continues
PSA's: .04 each test since surgery


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 8/6/2009 12:45 PM (GMT -6)   
I used to work for a health insurer (on the IT side). They were very focused on assigning nurses to cardiac and cancer patients to monitor and help with the treatments. Their research showed that it saves a bundle by treating patients early, rather than waiting until the treatments become more expensive. At least that was a party line...

Father died from poorly differentiated PCa @ 78 - normal PSA and DRE

5 biopsies over 4 years negative while PSA going from 3.8 to 28

Dx Nov 2007, age 46, PSA 29, Gleason 4+4=8

Decided to participate in clinical trial at Duke - 6 rounds of chemo (Taxotere+Avastin)

PSA prior to treatment on 1/8/2008 is 33.90, bounced on 1/31/2008 to 38.20, and down at the end of the treatment (4/24/2008) to 20.60

RRP at Duke (Dr. Moul) on 6/16/2008, Gleason downgraded 4+3=7, T3a N0MX, focal extraprostatic extension, two small positive margins

PSA undetectable for 8 months, then 2/6/2009-0.10, 4/26/2009-0.17, 5/22/2009-0.20, 6/11/2009-0.27

Salvage IMRT + 6 Months ADT: Casodex started 6/12/2009, Lupron 6/22/2009, PSA 6/25/2009-0.1, T=516, 7/23/2009-<0.05, T<10, IMRT to start mid-Aug


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 8/6/2009 1:48 PM (GMT -6)   
Larry, sounds like you were talking to a real moron, no mister, I am just having major surgery and risking incontinence and ED on a hunch. Geez, they could do better than that.
Age 57, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/11 ?
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, scarring closed up bladder neck, corrective laser surgery scheduled for 8/18
 
 


CPA
Veteran Member


Date Joined Feb 2008
Total Posts : 655
   Posted 8/6/2009 3:27 PM (GMT -6)   
Greetings, Larry.  Sounds like the person probably had a list of questions to ask with absolutely no common sense or subject knowledge.  Just go down the list of questions, write down the answers and check it off.  This is one of the reasons we have a health care crisis in this country - and no I'm not advocating for socialized medicine.  Reminds me of the old saying "I'm from the federal government and I'm here to help you."  Sometimes we just need some common sense.  David
Diagnosed Dec 2007 during annual routine physical at age 55
PSA doubled from previous year from 1.5 to 3.2
12 biopsies - 2 pos; 2 marginal
Gleason 3+3; upgraded to 4+3 post surgery
RRP 4 Feb 08; both nerves spared
Good pathology - no margins - all encapsulated
Catheter out Feb 13 - pad free Feb 16
PSA every 90 days - ZERO's everytime!
Great wife and family who take very good care of me

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