An appeal process exists for the insurance issue. My wife's insurance says no way, no how when approached about
paying, but it turns out that they DO pay for this procedure as they are mandated to cover it for Medicare patients. Well, I am not old enough yet to qualify. So I call on my insurance to cover it and at first it looks like they will only cover 80% due to it being out of state. Well 20% of the $37,000 or $44,000 cost of the procedure is $7400 or $8800 dollars to me, it would appear. (The numbers are the cost I have been quoted by Loma Linda, though Medicare gets a break, they only charge the Fed $21,000) Well appearances are deceiving, like so many things about
this disease. Loma Linda is part of the Blues Network and the Regence I carry through work is also a Blue Shield/Cross member. So for an out of state in network benefit Blue Shield/Cross will pay 80% till a $2000 deductable is met and then will pay 100%. Then I will get the wife's insurance to cover the 2 grand on the basis that they would have paid way more than that for me to have prostatectomy and subsequent follow-ups.
Do not get discouraged, do not take NO as an answer from your insurance. Have a 2nd opinion done on the pathology. It is highly subjective. Call Loma Linda and send them the info that they will request from you. It may take some time to collect it. Let them follow up with your insurance. They have people that do this every day. Above all do not give up!!
54 years old
PSA 5.6 on 3/20/07
Biopsy on 4/20/07
3 out of 12 cores positive, 2 on the right lobe with 5% adenocarcinoma Gleason 3+3, 1 on the left lobe 10% adenocarcinoma Gleason 3+4, overall Gleason graded 7 Cancer T1C. 2nd Pathology opinion concurs.
No scans recommended as seminal vesicle and lymph involvement is shown on nomograph as less than 1-2%. All physicians have agreed with this.
Dr. recommended Da Vinci Laproscopic RP, asked for 2nd opinion. Seattle Cancer Care recommended same. Asked for Radiation referral. Recommended IMRT. Scheduled Surgery for July 9th, 2007. Had 2nd thoughts about surgery and IMRT due to potential side effects. After web research discovered Proton Beam Therapy and called Loma Linda. Now scheduled for final consult with Dr. Luu on 7/5/07, our 27th anniversary.