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compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7205
   Posted 8/9/2010 6:45 AM (GMT -6)   
I was on their site and I could not find a place to email them with questions. They have phone #s and FAQ. So, my questions to this group:
 
1) Is there an email address to ask Medicare specific questions?
 
2) Do they cover the shingles vaccine?
 
3) It says they cover annual PSA tests. What about those of us PC patients who require tests every 3 months?
 
4) What about SRT? I know that is expensive. Is it covered?
 
5) I assume if one has a supplement plan it would help cover the above. True?
 
Mel

63 years old . PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (Free PSA 24%),  after 45 days on cipro! DREs have always been normal. PCA-3 was about 75 (way above the 35 threshold). That led to:

Biopsy on 11/30/09. 5 out of 12 cores positive. Gleason 4+3. 2 cores were 3+3 (one 5% and the other 30%) on one side. On  other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C.  

Surgery with Dr. Menon at Ford Hospital, 1/26/10. He says all looked good. Spared nerves. Unfortunately: Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland. Lymph Nodes: Clear.  Perineural Invasion: yes. Seminal Vessical Involvement: No.  Extraprostatic Extension: yes.  Positive Margin: Yes-- focal-- 1 spot .5mm. Final Weight is 52.7 gms.  (Second opinion from Jon Epstein at Hopkins confirmed these results)

 Incontinence: joined that club-- definite leaks—1 pad/day. Night is dry, was  using 1 pad at night for security, but pretty much dispensed with that most nights. Update: no pads at night. No pads while at home, but still very uncomfortable. Use 1 pad for out-of-house activities. Suddenly got MUCH better on 3/10/10, almost overnight. Still some urgency but no pads about 90% of the time.  As of 3/12/10--completely continent! Uh...OH. As of about 3/16/10 problems with constant urgency although no pads needed--feels like an infection but none showing in urine.

Update: since late March all is well in that area. I would say 99.9% continent (a spurt here and there, maybe 5 spurts per week). As of 6/22/10, I would say I am 100% continent, but I do have (controllable) significant urgency.

First post-op PSA on 3/10/10--DRUM ROLL: 0.01 Next PSA in mid-June.

Second post-op PSA on 6/21/10--0.02--Not too bad!


Jerry1
Regular Member


Date Joined Mar 2007
Total Posts : 460
   Posted 8/9/2010 9:46 AM (GMT -6)   
 
Mel,
 
I have Medicare (not an HMO medicare plan) and a supplement plan and have paid nothing out of pocket for any of my treatments (including surgery and SRT) or PSA blood tests.
 
Jerry1
Age 70
DX 8/13/08 , PSA 4.0, Biopsy 14 samples 1 positive 12% of sample,
Gleason Score 4+4 =8  Bone scan and MRI negative
Da Vince surgery on Oct 17, 08 Florida Hospital Dr Vipul Patel
Post Gleason report  4+4 = 8 Lymph nodes on both sides negative
margins Negative  Stage II (pt2a) 
Cath out on October 29th left in longer due to small leak.
11/19/08 dry no more pads
12/2/08 first PSA <0.1
 3/6/09 6 Month PSA 0.0
6/3/09 9 month  PSA 0.1
7/14/09  PSA still 0.1
10/15/09 PSA 0.3
10/26/09 surgery to remove 3 clips in bladder neck  
11/16/09 PSA 0.3
12/14/09 PSA 0.4 
12/28/09 PSA 0.5
Start salvage radiation treatments on January 18th. 
Finished IMRT
First PSA after 3 mos. 1.5 not good news


Postop
Regular Member


Date Joined Feb 2010
Total Posts : 385
   Posted 8/9/2010 9:56 AM (GMT -6)   
There is contact information on www.medicare.gov

MrGimpy
Veteran Member


Date Joined Jul 2009
Total Posts : 504
   Posted 8/9/2010 11:15 AM (GMT -6)   
I suggest you take some time and put together ( compile) all your questions then call them and ask

If you have a hard time getting through to a person , simply call one of the many supplemental companies (AARP is one), they will ONLY pay the balance of what Medicare pays, so it they pay it then Medicare covered it

Remember what is covered today can change from year to year
Stats:
Age: 52, PSA (2008)=1.9
Biopsy on 01/09/09, Gleason Score = 3+3
One (1) out of twelve (12) cores was positive, plus external nodule found
Surgery (Da Vinci, robotic prostatectomy): 4/7/09
Post Op Path 3+3
Removed Catheter: 04/19/09
100% bladder control - Pad free 7/09
PSA 7/09 undetectable, <0.01 - 3 months post-op
PSA 1/10 undetectable, <0.01 - 9 months post-op
Trimix provides 100% erectile function

Jerry1
Regular Member


Date Joined Mar 2007
Total Posts : 460
   Posted 8/9/2010 12:59 PM (GMT -6)   
Regal,
 
I am on Medicare and have had 4 PSA tests this year and all have been paid.  It is different once you have cancer then just the routine test.  They will also continue to be paid under the new health care reform.  However I also have a supplement with AARP and never had a problem.  
 
Jerry1 
Age 70
DX 8/13/08 , PSA 4.0, Biopsy 14 samples 1 positive 12% of sample,
Gleason Score 4+4 =8  Bone scan and MRI negative
Da Vince surgery on Oct 17, 08 Florida Hospital Dr Vipul Patel
Post Gleason report  4+4 = 8 Lymph nodes on both sides negative
margins Negative  Stage II (pt2a) 
Cath out on October 29th left in longer due to small leak.
11/19/08 dry no more pads
12/2/08 first PSA <0.1
 3/6/09 6 Month PSA 0.0
6/3/09 9 month  PSA 0.1
7/14/09  PSA still 0.1
10/15/09 PSA 0.3
10/26/09 surgery to remove 3 clips in bladder neck  
11/16/09 PSA 0.3
12/14/09 PSA 0.4 
12/28/09 PSA 0.5
Start salvage radiation treatments on January 18th. 
Finished IMRT
First PSA after 3 mos. 1.5 not good news


Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3747
   Posted 8/9/2010 2:24 PM (GMT -6)   
You can ask for "pre-approval" before you begin ANY treatment and then you know where you stand. While Medicare will pay almost 100% of any in hospital surgery, they will only pay 80% of the cost of radiation treatments, a big difference..Again, find out before you say "do it".
Age today: 68. Married, 6', 215 pounds, active, no health issues.
PSA at age 55: 3.5, DRE negative. Advice, "Keep an eye on it".
PSA at age 58: 4.5
PSA at age 61: 5.2
PSA at age 64: 7.5, DRE "Abnormal"
PSA at age 65: 8.5, DRE " normal", biopsy, 12 core, negative...
PSA at age 66 9.0 DRE "normal", BPH, Finesteride. (Proscar)
PSA at age 67 4.5 DRE "normal" second biopsy, negative.
PSA at age 67.5 5.6, DRE "normal" U-doc worried..
PSA at age 68, 7.0, third 12 core biopsy positive for cancer in 4 cores, 3 cores Gleason 6, one core Gleason 9. Finesteride discontinued, still no urinary symptoms, never had any..From age 55 to 65 I had no health insurance.

I have a date with the robo surgeon on Sept 3 but I'm keeping my options open. I'm also looking at seeds combined with IGRT which seems to be having good results with high-risk patients..

Postop
Regular Member


Date Joined Feb 2010
Total Posts : 385
   Posted 8/9/2010 2:52 PM (GMT -6)   
"but wait! when Bummer care starts they will pay for none lol!!"

A different view:

This board has many people on it with problems with health insurance, including people who went without screening or treatment because they didn't have health insurance. When health care reform gets fully put in place, everyone will be able to get health insurance. Don't you think that people who post here would really get it that's this would be a good thing? I don't believe that there is anything in the bill about PSAs, but I would gladly pay for my own if it means that I can be guaranteed to have health coverage if I get sick and really need it, and can't be dropped by my insurance company.

Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2458
   Posted 8/9/2010 6:09 PM (GMT -6)   
Mel,
PSA tests for PCa patients are all covered regardless of how many.
Age: 67 at Dx on 12/30/08
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed 2/9/09 Dr Fagin, Austin TX
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Posterior lateral lesions measuring 1.5 x 1.4 x 1.0 cm showing focal capsular penetration over a distance of 3mm in circumference.
Prostatic adenocarciroma accounts for approx. 10-20% of the hemisphere.
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx, Negative margins
seminal vesicles clean, lymph nodes: not dissected
continent after 5 months
2 months PSA test 4/7/09 result <0.1
5 months PSA test 7/9/09 result <0.1
8 months PSA test 10/9/09 result <0.1
11 months PSA test 1/21/10 result 0.004
14 months PSA test 4/19/10 result 0.005
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