Why preauthorization requests get rejected

New Topic Post Reply Printable Version
40 posts in this thread.
Viewing Page :
 1  2 
[ << Previous Thread | Next Thread >> ]

Tall Allen
Veteran Member


Date Joined Jul 2012
Total Posts : 8791
   Posted 11/8/2017 7:53 PM (GMT -7)   
It's not really surprising, but his blog highlights the importance of appealing rejected requests.

Milton Packer said...
Who Actually Is Reviewing All Those Preauthorization Requests?
Milton Packer thinks you should know how the system works

Several months ago, I was invited to give a presentation about heart failure to a group of physicians who meet every month for a lunch meeting. Don't worry. No company sponsored the talk, and I did not receive any payment. I accepted the invitation, because it seemed like to good thing to do. However, the audience was a bit unusual for me.

Among the 25 physicians in the room, nearly all were in their 70s and 80s. All were retired, and none were actively involved in patient care. I guess that explains why they had time in the middle of the day for an hour-long presentation. I gave my talk, but there were no questions. I had a few moments afterwards to speak to my audience. Since the physicians were not involved in patient care, I wondered why they wanted to hear a talk about new advances in heart failure.

The response surprised me: "We no longer care for patients, but we care about what's going on. You see, most of us are employed by insurance companies to do preauthorization for drugs and medical procedures."

My jaw dropped: "I just gave a talk about new drugs for heart failure. Are you responsible for preauthorizing their use for individual patients?" The answer was yes. I was really curious now. "So did I say anything today that was helpful? I talked about many new treatments. Did I say anything that you might use to inform your preauthorization responsibilities?"

Their answer hit me hard. "Oh, we've heard about those drugs before. We're asked to approve their use for patients all the time. But we don't approve most of the requests. Nearly all of them are outside of the guidelines that we are given."

I stammered. "I just showed you evidence that these new drugs and devices make a real positive difference in people's lives. People who get them feel better and live longer."

The physicians agreed. "Yes, you were very convincing. But the drugs are too expensive. So we typically reject requests, at least the first time. We figure that, if doctors are really serious, then they should be willing to make the request again and again."

I was astonished. "If the drugs will help people, how can you say no?"

Then I got the answer I did not expect. "You see, if it weren't for us, the system would go broke. Every time we say yes, healthcare becomes more expensive, and that isn't a good thing. So when we say no, we are keeping the system in balance. Our job is to save our system of healthcare."

I responded quickly. "But you are not saving our healthcare system. You are simply making money for the company that you work for. And patients aren't getting the drugs that they need."

One physician looked at me as if I were from a different planet. "You really don't understand, do you? If we approve expensive drugs, then the system goes broke. Then no one gets healthcare."

Before I had a chance to respond, he continued: "Plus, if I approve too many expensive drugs, I won't get my bonus at the end of the month. So giving out too many approvals wouldn't be a smart thing for me to do. Would it?"

I walked out of the room slowly. Although I had been invited to share my knowledge, it turned out that -- this time -- I was the real student. The physicians in the audience taught me a valuable lesson. And amazingly, none of them showed a single slide.

Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

Bohemond
Veteran Member


Date Joined Apr 2012
Total Posts : 845
   Posted 11/8/2017 8:34 PM (GMT -7)   
Having had several battles with insurance companies I'm not surprised. If you persist and escalate, a default initial no can often be turned into a yes. All it takes is hours of your time and a growing pile of letters and documents attached to each succeeding round of the battle.

I had a battle royal with my employer's dental plan insurer years ago over $7,000 worth of dental work for my wife. The insurer was only on the hook for the annual maximum of $2,500 but they insisted they would pay only $400 for a partial denture rather than a permanent bridge. It took nearly a year including letters from her dentist, from my wife, from my HR department and eventually an appeal to the insurer's allegedly "outside" appeal board. But they eventually gave in a paid up. I'm convinced the hurdles are put in place on the assumption that most people will give up out of frustration.
Age 71
-2002-PSA 9.4, 5 of 10 cores positive - 30-50%.
-RP April 2002. PT3B N0 MX Gleason=7 (3+4), 75% left lobe; small focus rt lobe.
-PSA low of 0.01; slow rise to 0.4 (Aug 2009).
-SRT Jan/Feb 2010. One lymph node targeted. Casodex 3 months during SRT -PSA 0.00 through Apr 2014;
-0.02 Oct 2014; 0.04 Apr 2016; 0.23 Oct 2016; 0.51 Jan 2017; 0.64 Mar 2017, 0.92 Jun 2017, 1.54 Oct 2017

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3554
   Posted 11/8/2017 11:01 PM (GMT -7)   
Which leads us to the question: Is our healthcare system sustainable??

I read somewhere that the leading cause of personal bankruptcy in the U.S. was medical bills....
Age now 75 . Diagnosed G-9 6/2010. RALP, Radiation failed
Lupron, Zytiga, PSA <0.1 10/16 no change <0.1 5/17 PSA 1.6 Chemo or Provenge next..Sept '17, PSA now 9.2. ADT including Zytiga has failed. Will investigate treatment options. 11/17 PET/CT clear, but 4 new bone mets..Going to try Xtandi and see how I respond to that..

Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4774
   Posted 11/9/2017 3:34 AM (GMT -7)   
It's not just healthcare. All sorts of adjusters are trained to deny claims in hopes that they simple go away.

John_TX
Veteran Member


Date Joined Jan 2015
Total Posts : 856
   Posted 11/9/2017 6:56 AM (GMT -7)   
Insurers' objective is to keep your money and their money.
DX - 1-13-2015 (age 66) -- PSA 4.02 (9-16-2014) to 4.38 (12-5-2014)
RALP on March 2, 2015
G6 to G7(3+4) to G7(4+3)
Stage pT3aN1
10/2017 PSA < 0.1
7/31/2015 HT - six month's injection of Lupron
ART 11/2015, 33 sessions

JNF
Veteran Member


Date Joined Dec 2010
Total Posts : 3388
   Posted 11/9/2017 7:32 AM (GMT -7)   
But before you beat up on the private sector insurance companies for doing this, remember that when it is the government running the health care the same will happen. We already have rationing in out USA government run healthcare (Medicare, Medicaid, VA, etc. and in most all countries around the world). It is one element of rationing. I am not defending it, just clarifying that it is not limited to the private insurance companies.

All around the world this is happening and will continue. Rationing is far more prevalent and harmful in most countries than it is here. Rationing is a significant hallmark of government run health care. The payor gets to decide what they pay for. Another way of looking at the economic Golden Rule, He who has the gold makes the rules. At least here in the USA the individual can choose to pay for the drug or procedure even when the third party payor chooses not to.

I encourage you to read the works of one of the ACA architects, well known medical ethicist Ezekial Emmanuel, regarding healthcare rationing. It simply has always been a way of life and will continue to be. Understanding it and future expectation is a good basis for everyone's financial plan for healthcare costs.
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard and Jalyn started on 10-7-2010. IMRT to prostate and lymph nodes started on 11-8-2010, HDR Brachytherapy December 6 and 13, 2010.
PSA < .1 since February 2011. Located in Cumming Georgia north of Atlanta

Post Edited (JNF) : 11/9/2017 7:44:31 AM (GMT-7)


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7183
   Posted 11/9/2017 8:13 AM (GMT -7)   
JNF:

If you are going to compare our country with other countries, then perhaps you should also point out that other countries do at least have Universal Health Care. We don't. Consequently, many folks do not have any insurance.
I would guess that almost all of us HW folks do have health insurance.

This is not meant to detract from the sad fact that sick folks, often with little energy, get denied from having needed drugs. I am appalled that doctors -- working for insurance companies -- routinely deny such care in order to get bonuses. I suspect they use the "saving the healthcare system" line as a rationalization. It's all about the money. Here I always had the image of health care administrators -- not doctors -- denying care to get their bonuses/salary.

Mel

Ravineman430
Regular Member


Date Joined May 2014
Total Posts : 157
   Posted 11/9/2017 8:49 AM (GMT -7)   
How can anyone be surprised. Insurance companies exists only to take money, and pay out as little as possible. They don't give a darn about their policy holders as long as they pay their premium. The minute they have to pay out on a claim, they do anything possible to NOT pay the claim or pay as little as possible.

Insurance companies are for the most part evil.
PSA before RRP May '14 6.44

Removed prostate, seminal vessels. G7 (3+4) 5% involved
pT2c Post RRP PSA <.05. 8 month post RRP PSA 0.12
33 SRT treatments finished May 4, 2015

October 2016 PSA still undetectable

searchinginla
Regular Member


Date Joined Apr 2017
Total Posts : 115
   Posted 11/9/2017 9:02 AM (GMT -7)   
Shocker! I experienced this first hand. We had to submit our plan for SBRT three times before it was accepted.
The reason; it was considered experimental. The doctor who signed off on the denial was a.... wait for it....pediatrician.

Post Edited (searchinginla) : 11/10/2017 11:30:51 PM (GMT-7)


142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6746
   Posted 11/9/2017 10:51 AM (GMT -7)   
I can't even begin to list the hoops and hurdles of denials and appeals I've done in 8 years of not dying on schedule.

On the other hand, having to have made ugly business decisions in my past, if the company goes bust, no one wins.

Please do keep this away from ANY POLITICAL comment, as that will end badly.
NOTE _ MY EMAIL HAS CHANGED!
Moderator - Prostate Cancer
(Not a medical professional)
DaVinci 10/09
IGRT journey (2010) -
www.healingwell.com/community/default.aspx?f=35&m=1756808
HT (Lupron) 9/12-3/13, 6/14 to present
Prolia 6-mo inj 12/12 to present
Casodex started 12/14, end 3/15 after psa 30% rise
Zytiga 04-07/15 Xtandi 04/16-8/17
Taxotere 10/17-?

Explorer59
Regular Member


Date Joined Feb 2012
Total Posts : 186
   Posted 11/9/2017 4:39 PM (GMT -7)   
No surprise with what was in the originally posted article. My experience is that an appeal is worth the time, but be prepared for the long haul or they will wear you down. Even renewed prescriptions for the same medicine that the good doctor prescribed last year end up going through the gauntlet again.
PSA: 3.5 to 5.1 in 3 yrs
Biopsy: 4/11, 3 of 12 +, G6
RALP: 7/11, catheter 6 days
Path: G6, 56g, <5% cancer, neg margins
PSA undetectable, continent, recovered from ED

halbert
Veteran Member


Date Joined Dec 2014
Total Posts : 3103
   Posted 11/9/2017 7:33 PM (GMT -7)   
Of course it's about the money. And, it's true, every medical system has built in rationing, if you want to call it that. Someone, somewhere is making decisions about who gets what care. No way around it. Except for those who have way above average bank accounts, we are all at the mercy of someone who is making an economic judgement about our case.

I consider this thought: a few years ago, I had an emergency appendectomy (is there any appendectomy that ISN'T an emergency?). The day after surgery, I developed pneumonia and was back in the hospital for 3 days of IV antibiotics. The total billed amount for the whole thing was over $60K. If I had had to pay that out of pocket (even if I could have negotiated a discount equivalent to what Blue cross got), I still would have been on the hook for over $30K. I'd still be paying on it. And that was for a relatively inexpensive situation.

Who, in reality, has that kind of money laying around? For the vast majority of us, the answer is "no one I know".

There is, unfortunately, no good answer.
Age at Diagnosis: 56
RALP on 2/17/15, BJC St. Louis, Dr. Figenshau
58.5g, G3+4, 20%, 4 quadrants involved
PSA 3/10/15: 0.10
5/18/15: <.04
8/24/15: <.04
11/30/15: <.04
2/29/16: <0.04
8/30/16: <0.04
2/15/17: <0.006
8/22/17: <0.006
My Story: www.healingwell.com/community/default.aspx?f=35&m=3300024

Gemlin
Veteran Member


Date Joined Jul 2015
Total Posts : 603
   Posted 11/10/2017 9:26 AM (GMT -7)   
Where I live (Sweden) we have a public health care system financed by taxes and available to all. We have similar problem I believe. The gap grows between the care that there are medical and technical opportunities to perform and the resources available to provide such care.
While the new expensive drugs can help severely sick with rare diseases, other care is taken away. A hard equation.
If we add incredibly much to a patient or a small patient group, then other patients will be without, we lose lives at the other end instead. So in some sense, we will face the problem that we must actually put a price on a life, how unpleasant it may be.
Age at detection: 60
PSA 4.1 2014-02-25
Biopsy 2014-04-24, 4 of 10 cores positive, G: 3+4,4+3,4+3 EPE,4+3. PNI+
Bone scan negative
DaVinci 2014-08-31, nerve sparing right side
Prostate 35 g, 46x37x38 mm
Tumor dorsal PZ, SV-, 14 LN-, SM-, pT3a, G7 (4+3), EPE+ left side
PSA:
2014-10 <0.05
2015-03 <0.05
2015-09 <0.05
2016-03 <0.05
2016-09 <0.05
2017-09 <0.1

mattamx
Regular Member


Date Joined Aug 2015
Total Posts : 219
   Posted 11/10/2017 10:22 AM (GMT -7)   
This may be TMI, but I’m okay with the judgements people may have about me. I happen to be on Medicaid. I am only able to work half-time and so I simply cannot afford to buy insurance. I will be headed to ADT soon and my MO plans to have me on Zytiga. An issue I struggle with is the taxpayers having to pick up the tab for that drug. The cost of the drug outrages me and I feel that it’s criminal. I have seriously considered taking my own stand by refusing to participate in a drug treatment that I view as a scam.

I dislike being part of a healthcare trend that seems unsustainable. Where is the line drawn?

Post Edited (mattamx) : 11/10/2017 10:25:53 AM (GMT-7)


John_TX
Veteran Member


Date Joined Jan 2015
Total Posts : 856
   Posted 11/10/2017 11:02 AM (GMT -7)   
mattamx said...
.... I happen to be on Medicaid. I am only able to work half-time and so I simply cannot afford to buy insurance. ...... An issue I struggle with is the taxpayers having to pick up the tab for that drug....
And you are exactly the appropriate recipient for that kind of assistance! You want to work but cannot full-time due to physical constraints. Those in need should receive it. There's even some young military families getting food assistance because an E1-E3 (or even O1, O2) don't make a bunch of money.

Somebody mentioned the VA as an example of rationed health care - those of us in the system can fully relate to that statement. It took two weeks for me to be seen by a VA dentist for an urgent situation. I've been waiting for over two weeks just to talk to somebody about getting an MRI scheduled for my back.

I've been very blessed to have good medical insurance when working and when retired (I retired from a Fortune 5 company).
DX - 1-13-2015 (age 66) -- PSA 4.02 (9-16-2014) to 4.38 (12-5-2014)
RALP on March 2, 2015
G6 to G7(3+4) to G7(4+3)
Stage pT3aN1
10/2017 PSA < 0.1
7/31/2015 HT - six month's injection of Lupron
ART 11/2015, 33 sessions

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4148
   Posted 11/10/2017 12:24 PM (GMT -7)   
all the current arguments about our health care system is over WHO PAYS, and not what is an effective delivery system for health care. At 17% of our total GDP and an average of $10,000 annually per person the system is not financially stable. If our costs were 10% we would not be having these arguments.
getting it down to 10% means rationing pure and simple and making tough decisions. 70% of our health care costs are used in the last two years of life, so perhaps that's where we should start looking.

81GyGuy
Veteran Member


Date Joined Oct 2012
Total Posts : 2068
   Posted 11/10/2017 12:58 PM (GMT -7)   
John T said:

"70% of our health care costs are used in the last two years of life, so perhaps that's where we should start looking."

That thought brings to mind one approach to cost reduction that
I'm not sure we have discussed all that much here in forum threads: the substantial changes in our social structure that have occurred over the past century or so, changes which have significantly impacted increases in medical costs.

(Granted this may be getting a little away from the original thread topic, but since it's cost reduction related, and especially in view of John T's above figure of 70 %, maybe I could make a quick comment about it).

In fact, some of these changes were discussed, as some of you who participate in the forum book club may remember, when we talked about Atul Gawande's "Being Mortal" a few months ago.

In his book Gawande made the point that even just a few decades ago it was common practice for families, as least in the U.S., to take in elderly relatives to live out their lives within the family structure, at a time when the hospice concept was still in the future (late 1960s at the earliest).

I know this is true because it happened in my family. In 1956, when I was 10 years old, my great-grandmother came to live with my father, mother and me. As a child I was pleased that "great-grandma" was coming to stay with us, but nobody told me at the time that she was really coming to die with us. I guess because of my age no one felt it necessary to inform me that she had been hobbled by a series of heart crises, had been given only a short time to live, and because it was family tradition, it was now incumbent upon the family, and not the state or some institution, to see to her care in her last days, by taking her in.

She stayed in the guest room, which became her room, and my mother became her caretaker, with very frequent visits by my grandmother ("great-grandma's" daughter).

I still remember after all these years the sad day when I came home from school in the afternoon one spring day to be told by my mom that "great-grandma" had passed on that morning.

It was the end of a cycle that had been going on in my family for generations: the older relatives staying with and living their final days with the younger ones.

Two points. The first is that this form of home care undoubtedly saved a great deal of money, that would have had to be spent, if my great-grandmother had had to go into some kind of institutional final care.

But the second point is: how many modern families are either in a position to perform this kind of home-based caregiving, noble as one would concede that it is, and regardless of possible cost savings, with virtually all of us working now, or living in different parts of the country? It’s simply no longer feasible for many (most?) of us, and Gawande makes this point in his book.

But to a degree I am perhaps the 21st century version of this kind of family-based caregiving. My mother, who turned 97 recently, lives in a senior-oriented condominium about a 15-minute drive from my house If necessary, I can drive to her quickly, if she has not already needed to push her Life-alert button. At this point I do most everything for her now (bill-paying, grocery shopping, transportation to appointments, and the like) while a daynurse makes regular visits during the week to take care of her personal needs such as bathing or taking medications. (Mom isn't officially in hospice status, but because of her age-related disabilities, she is very much in a position similar to that of my great-grandmother back in 1956).

Will Mom out of necessity have to move into a nursing home at some point? We don’t know yet, but for now I am, as noted, doing the 21st century version of taking into one's home, so to speak, the elderly relative.

And so far the only cost to Mom is that daynurse. She owns her condo, and so far Medicare and a small pension is taking care of her medical and other, small needs, primarily food and utilities. Contrast that to the cost of living in a retirement community.

Apologies if this has been a bit long, but the point I have tried to make is that if some way could be identified to involve families more in the care of their aging relatives, instead of relying on an institutional, and expensive, approach to achieve this, state or otherwise, perhaps at least some of the costs could be reduced.
Age: 71
Chronic prostatitis (age 60 on)
BPH w/ urinary obstruction, 6/2011
TURP, 7/2011
Ongoing high PSA, 7/2011-12/2011
Biopsy, 12/2011: positive 3/12 (90%, 70%, 5%)
Gleason 6(3+3), T1c
No mets, PCa likely still organ contained
IMRT w/ HT (Lupron), 4/2012-6/2012
PSAs (since post-IMRT): 0.1 or lower

Post Edited (81GyGuy) : 11/10/2017 3:13:10 PM (GMT-7)


halbert
Veteran Member


Date Joined Dec 2014
Total Posts : 3103
   Posted 11/10/2017 6:28 PM (GMT -7)   
81, I think all of us can recall situations where an elderly person's family went crazy and overboard. I remember watching a situation where a woman in her 90's first developed colon cancer, and they did major surgery then started a standard chemo course--that would take 2 years. Then, 6 months or so later she fell and broke a hip, and they put in a prosthesis. Within another 3 months she died. It struck me as crazy.

That being said, I experienced this spring just how hard it is to know when you're on the slippery slope with an elderly patient. 2 years or so ago, my mother (then 86) developed a bowel blockage, and they gave her a temporary colostomy which they went in a few months later and reversed. In April this year, she developed another blockage. They repaired it and found that it was an old adhesion. Well, during the surgical recovery..after they took out the feeding tube, she aspirated and developed pneumonia. She never left crit care, and finally on June 10, we took her home with hospice and she died on June 15.

So, in that case, when did we start down the slope? With the surgery? Later? When later? It's not easy to see even in retrospect, much less than in real time.

Back to the original OP: Like it or not, decisions are made every day about the cash value of a particular life. It's inevitable, no matter what system is used. Making political hay out of 'death panels' makes a great soundbite, but it doesn't help with finding solutions.
Age at Diagnosis: 56
RALP on 2/17/15, BJC St. Louis, Dr. Figenshau
58.5g, G3+4, 20%, 4 quadrants involved
PSA 3/10/15: 0.10
5/18/15: <.04
8/24/15: <.04
11/30/15: <.04
2/29/16: <0.04
8/30/16: <0.04
2/15/17: <0.006
8/22/17: <0.006
My Story: www.healingwell.com/community/default.aspx?f=35&m=3300024

Bohemond
Veteran Member


Date Joined Apr 2012
Total Posts : 845
   Posted 11/10/2017 7:33 PM (GMT -7)   
My wife and I brought her mother over from England in the late 1990s. We'd reached a point where my wife was quite literally spending more time in the U.K. then here to get her mother to medical appointments, make sure the house was maintained, the refrigerator and pantry stocked etc. We owned a business at the time researching and writing newsletters so we put a separate phone line into her mother's house in England so my wife could keep a business phone and printer/fax machine there so she could bring her laptop and work on either side of the pond. It was costing us a fortune in air fares plus paying for people to check in on my MIL, cut grass etc. when my wife wasn't there.

I renovated our house so my MIL could have our dining room as her bedroom and our living room as her own space. We put those rooms on a separate heating zone so she could run the heat as high as she wanted. To make this work I also had to build a downstairs bathroom -- which required completely moving our back door and outside stairs, moving our own living room to the second floor, converting our attic to a master bedroom. Etc. A year's worth of my nights and weekends and another small fortune, even with my own labor. But in the end we were able to move my mother-in-law over here for the last five years of her life.

Over those five years she had an increasing number of medical crises - the most serious relating to a failing hip replacement she'd had done in the U.K. Long story short, the hip ultimately led to septicemia, several stays in the hospital followed by IV antibiotics administered at home by my wife and visiting nurses, and ultimately hospice at home.

Looking backward it is still hard to know at what point could we or medical professionals say this is the point of no return (or the point of throwing good money after bad if you are the insurer). But I think the call was pretty close to correct. When her doctors recommended hospice at home the alternative was further surgery that she may not have survived and if she did she would probably have ended up with an amputation at the hip at age 93, with little guarantee that the surgery would even extend her life. Her quality of life remained good over the nearly five years she lived with us after moving from England. And had she stayed in England, she would have certainly ended up in a nursing home and probably not lived as long or as well.

And now we are looking at something similar with my mother, who will be 93 in January. I was at her house today raking and mulching leaves. She's still in her own house, but the hospital admissions followed by rehabs at our house are coming more frequently.

I'm on the brink of ranting about siblings who are missing in action .. but some things are beyond our control.
Age 71
-2002-PSA 9.4, 5 of 10 cores positive - 30-50%.
-RP April 2002. PT3B N0 MX Gleason=7 (3+4), 75% left lobe; small focus rt lobe.
-PSA low of 0.01; slow rise to 0.4 (Aug 2009).
-SRT Jan/Feb 2010. One lymph node targeted. Casodex 3 months during SRT -PSA 0.00 through Apr 2014;
-0.02 Oct 2014; 0.04 Apr 2016; 0.23 Oct 2016; 0.51 Jan 2017; 0.64 Mar 2017, 0.92 Jun 2017, 1.54 Oct 2017

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4148
   Posted 11/10/2017 9:09 PM (GMT -7)   
81,
Good points that are major issues. A friend of mine died of lung cancer last year, it went to his bones before he was DXed. He was given an artificial hip 8 weeks before he died. No other country in the world would have done this. Major testing and procedures are given to patients with very limited life expectancy. These limited resources could be better allocated to society. Also when someone else is paying the bill there is no incentive for the patient or doctor to save money, especially when costs are not easily determined.
70 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, 4 weeks of urinary frequency and urgency; no side affects since then. 6 years of psa's all at <0.1.

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3554
   Posted 11/10/2017 10:34 PM (GMT -7)   
I saw this published somewhere...Americans, all of us, spend on average $9500 a year on medical treatment. In India, that number is $250...In Pakistan, the number is $150...
Age now 75 . Diagnosed G-9 6/2010. RALP, Radiation failed
Lupron, Zytiga, PSA <0.1 10/16 no change <0.1 5/17 PSA 1.6 Chemo or Provenge next..Sept '17, PSA now 9.2. ADT including Zytiga has failed. Will investigate treatment options. 11/17 PET/CT clear, but 4 new bone mets..Going to try Xtandi and see how I respond to that..

halbert
Veteran Member


Date Joined Dec 2014
Total Posts : 3103
   Posted 11/11/2017 5:36 AM (GMT -7)   
John T, exactly the point that Gawande made in Being Mortal. We don't want to admit it, but with the elderly in particular, and with the terminally ill in general, we are p-poor at saying, "It's time to stop!"

As I think back to this spring with my mother, the one thing I'm pretty sure of, is that when they found pneumonia, my daughter who is an RN starting saying things to us that were, in retrospect, telling us that the end was coming, and it wouldn't matter how many times they drained fluid from her chest, or how many different antibiotics they tried. (Hows that for a horrible run on sentence full of comma splices?) Should we have taken her home sooner and had her pass a week or two earlier? I don't know.

This IS where I think there need to be more actual conversations about situations in real time, where the doctors, nurses, and family sit around a room and make a reasoned decision about prognosis BEFORE a major step is taken (hip replacement in a 90 year old? another major abdominal surgery in an 88 year old with immune system problems?). These aren't easy conversations to have, and they take time none of the professionals have available, and (most important to the OP) insurance won't pay for it. In the end, however, they would save a lot of patient suffering AND a lot of money.
Age at Diagnosis: 56
RALP on 2/17/15, BJC St. Louis, Dr. Figenshau
58.5g, G3+4, 20%, 4 quadrants involved
PSA 3/10/15: 0.10
5/18/15: <.04
8/24/15: <.04
11/30/15: <.04
2/29/16: <0.04
8/30/16: <0.04
2/15/17: <0.006
8/22/17: <0.006
My Story: www.healingwell.com/community/default.aspx?f=35&m=3300024

Skypilot56
Regular Member


Date Joined Mar 2017
Total Posts : 205
   Posted 11/11/2017 6:11 AM (GMT -7)   
Wow! Hold on guys we need to look at the other end of this story!!! Have any of you been to the emergency room lately? Who's there? A very young crowd with many young kids looking for some more well lets just say pain medicine for which all of us on here know what it's used for! My Grandson's mother is head emergency nurse in downtown Minneapolis ask her what the problem is over 75% of their time is spent dealing with this crowd of people she says the doctors are not able to spend time with real emergency patients because they are dealing with the crowd. So if we want to talk about controlling life in our senior years how about starting with this crowd at a young life cause were sure darn gonna pay much more over the years for these people than we are for the senior citizens who have paid into the system all their lives!!!! Ask the doctors nobody is talking about prevention!!!! When are we gonna wake up America? How many times did we go to the doctor when we were kids? I remember twice to get my tonsils out and the time I fell and broke open a cut on my head and my father screaming at me because how was he gonna pay to stich it up If I remember right it was 20 dollars at the local doctor in our little town who worked out of his house? I lived through 6 years of my dear mom going through hell with ALS in my opinion the worst disease there is but up until two days before she passed away she was fighting as much as her poor pain riddled body would let her!!! Did she deserve to live this long? Absolutely! My Dad served in Korea, they paid their taxes, paid their bills even tho they didn't make a ton of money! If everybody paid into the system and didn't abuse it there would be plenty of money!
Every store, every fast food, every gas station, every business in America is looking for help! If people would work and pay their fair sure and if we got the corporate welfare out of the medical gouging that's going on we could probably cut taxes for health care!!!!!
Male 61 DX @ 60
Father had PC
2002. Psa. .08 Enlarged Prostrate
2014. Psa. 3.8
2016. Psa. 19
3-08-17 RP Mayo Clinic Mn
Path Report: Gleason 9, pt3b, Seminal vessels and one nerve removed, negative margins, 35 lymph nodes removed no cancer, Prostrate 45 grams
4-20-17 Incarcerated Umbilical Hernia
6-13-17 1st psa check 0.13
7-19-17 psa 0.12 MRI clear
10-11-17 psa 0.16
10-12-17 Lupron started

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6746
   Posted 11/11/2017 7:45 AM (GMT -7)   
OK folks, we are reaching the edge of the political red line. Step back one, please.

mattamx
Regular Member


Date Joined Aug 2015
Total Posts : 219
   Posted 11/11/2017 11:06 AM (GMT -7)   
I understand the frustration that people can feel when they believe other people are gaming the system, and there are always going to be people who cheat any system. My opinion is that the vast majority of people getting entitlements need them. I work as a peer in mental health and it touches me that most of them say they wish they could trade their disability for the ability to work
The tragic recommendations of the USPSTF led me to where I am.
Dx: April 2015, Age 54, pT3bN0MX
Initial PSA: 20.8
Bx: All cores high volume G7 (4+3)
Bone scan and MRI: clear
RALP: June 2015
Pathology: G8 (4+4), focal areas of 5; Positive margins; 3 Nodes negative
Adj. IMRT: Aug 2015
PSA nadir: 0.1
Steady PSA increase. Recent PSA: 5.3
CT and bone scans, July 2017: Both clear
New Topic Post Reply Printable Version
40 posts in this thread.
Viewing Page :
 1  2 
Forum Information
Currently it is Saturday, November 18, 2017 10:14 PM (GMT -7)
There are a total of 2,895,270 posts in 317,778 threads.
View Active Threads


Who's Online
This forum has 157381 registered members. Please welcome our newest member, EDinNJ.
259 Guest(s), 8 Registered Member(s) are currently online.  Details
Tagier, Pirouette, Michael_T, astroman, Lmgraff, EDinNJ, Lolii, BOB 46


About Us | Advertise | Donate
Newsletter | Privacy Policy & Disclaimer
Follow HealingWell.com on Facebook Follow HealingWell.com on Twitter Follow HealingWell.com on Pinterest
©1996-2017 HealingWell.com LLC  All Rights Reserved.