Cancer Survivors Network

LRP
$30K HOSPITAL
$18K-SURGEON--I paid 16k out of my pocket.

Lion1

Thomas e. ahlering...............714 456- 6068 appt.

Thanks to all of you for looking up those figures, and the phone number. Wow! Those prices are as bad as I had feared. Doing it in the US may not be possible for me. I'll keep looking around, and check out Irvine. I've heard that it may be possible to negotiate with some hospitals for the insurance company price. I'll see what I can come up with. Do any of you know if the price your insurance company paid was lower than the price that you quoted to me?

I had my biopsy done in Bangkok. They took 24 cores. The right lobe showed no cancer, and the left showed cancer in 9 out of 12, but I don't know the percentage in each. The slides just arrived at Johns Hopkins yesterday for a second opinion.

The urologist surgeon in Bangkok who did my biopsy does robotic assisted surgeries. He's done 180. He is supposed to have the most in Thailand, and he says he's got more than the leader in Singapore. I'm hearing that over 250 is a better bet. When I read of surgeons doing 1800 in the US, it sounds much better to me.

You are correct that there is a difference in cost. In my case there were things that the insurance would not pay, but were written off up front (mine only pays 6 biopsy cores, the Dr. won't do less than 12, and the lab has an agreement with the Dr. that helps cover the difference).
There were a number of items considered "not covered" that were written off or reduced with some polite conversations (I have found some amazingly considerate people out there).
The insurance companies in general also have fixed price or fixed percentage agreements for a long list of procedures with "in-network" providers and hospitals, which may not be the closest or the one you are familiar with.
I can't say in detail what rules apply - I couldn't make sense of how some numbers were arrived at, but I would say the insurance company spent about $18,000, while I spent something over $5,000 (in respect to the hospital & doctors).
If I had not been extraordinarily careful about selecting doctors and facilities that were within the insurance company's network, my part would have been at least $12,000, perhaps much more. This level of attention had to be kept up at every point I signed anything.

And I pay a significant insurance premium, which can't be ignored in the total "cost".

I am very lucky with the company I work for has pretty good insurance. My annual maximum out of pocket is only $950. Since I met that with all the doctors seen since discovered in Oct 09 I wanted to get the operation done in 09 thus avoiding the additional $950 I'd be spending immediately after the Operation if I choose to wait and do in Jan or Feb. My entire operation cost will cost me $0 all covered 100% by insurance...however the doc's and hospital will not be getting at all what they billed. For example just got what the Insurance covered of the $26,015.00 hospital bill...insurance on paid them $10,997.15 making the provider eat the rest....right now I am loving my job and thank God for the insurance the company has - Anthem Blue Sheild Blue Cross. Can't wait to see the Dr's bills and see how the insurance denies them thousands...it's simply rediculous the cost charged on some line items. Now the surgeons...getting rid of my cancer...that is priceless and if forced to I would pay just about any amount...somehow.

Randy in Indy

Remember that you get only one prostate operation, so you want the best....

I have medicare and a bluecross suppliment.........i notice that the various doctors that I saw ask more than what they accept thru these coverages..........so I think that you might be able to negotiate.....check out a few docs for price.

As far as dr ahlering.........At a support group, I spoke with a physician who had the operation with him, and asked for a professional discount//////he did not receive it......

What other countries are you considering for an operation, israel, austraila (sp), taiwan, etc

Where are you from in the US, do you have a support group and a place to stay?

ira

Hopeful and Opt...

I work in Japan and spend part of the year in Thailand with my wife who is from there. I have insurance in Thailand that will pay for an operation there, but I haven't found a surgeon with very high numbers there. That same insurance will reimburse me for surgery in any other country except the US. I'd still have to come up with the cash, but could get it back from them if I could get it pre-authorized.

So, I could do it free in Thailand, but maybe with a less experienced surgeon. Doesn't sound too appealing. I could do it in the US, where it sounds like the best surgeons are, but I will have to pay for it all. Still, I want to do this right.

Another option is doing it in some other country where I can find a high volume surgeon, pay for it up front, and hopefully get a refund. That would be great. But finding a surgeon that I can trust in an unfamiliar country is an overwhelming task. I'm looking into it, but just scratching the surface at this point. Japan isn't looking too promising.

I grew up in northern California, but don't have family there any more. I have siblings in the Seattle area and the outskirts of New york City, so I have places to stay, there. I am looking around the New York area, because there are many famous hospitals there and in neighboring states. My sibling there is a cancer survivor (8 years). That is my support group in the states at the moment.

however in nyc there are top doctors, there are two robotic surgeonsthat are supper stars in NYC........I not home now, so I will have to get back to you

Ira

ashutosh k. tewari, md

From my perspective, the numbers you are stating above for the "experienced" di Vinci surgeon in Thailand are not high. No matter what procedure you get from my perspective you want a doctor with experience and excellent provable stats….

I am having Open Surgery up in Chicago soon but Dr. Shah out of Atlanta is an excellent di Vinci surgeon with about 1200 under his belt + CNN did a piece on him back in 2006 (you can google it)…best of luck in this thought process

The Seattle Cancer Care Alliance (Fred Hutchinson Cancer Research Center & University of Washington Medical Center)was recently ranked as 5th best cancer center in the US by US News & World Report. It is listed as one of the top 10 cancer centers in the US by all rating services that I've checked. I had an open procedure done there on March 11, 2011 by Dr. William Ellis, but he is also considered one of the top robotic surgeons. My wife also had her breast cancer treated at the same center, so we can both verify the excellent quality of care provided there. The website is http://www.seattlecca.org/. Good luck in your search.

John
Seattle, WA

2ndBase

What type of radiation treatment did you have? I have heard that some can cost more than surgery.

Yeah, that's what I was afraid of. I have to pay for anything in the US out of pocket. Johns Hopkins has quoted me surgery at around $21,000. Surgery in Sydney, Australia is around the same price. If I can come up with that amount, that's probably the route I will go. Right now, I am still trying to see if I can pull that amount together. It's a struggle at this point. This was all a big surprise, of course, as I'm sure it was for everyone here.

MCK,

I am truly sorry that you find yourself in this difficult strait. I don't understand your situation completely or why being an overseas teacher made you ineligible for insurance unless you decided to opt out of coverage your employer may have offered.

Treating prostate cancer without insurance can be extremely expensive as you're starting to realize. I think your estimate of $40-75K for surgery and associated hospital costs is probably on the conservative side but it varies greatly across the country. Other treatment options are likely to be in the same price range but it is extremely difficult to get exact estimates in advance of treatment.

While I understand that cost is a major factor in your decision process today I strongly urge you to first consider the best treatment for your husband's condition and it very well may not be robotic surgery as the first urologist suggests. Most men who go through this process seek multiple second opinions and only knowing a Gleason 6 score is simply not enough information to give you much advice based on experience other than very general guidelines.

In general, a Gleason 6 score is considered less threatening that higher Gleason grades but much depends upon the PSA history, physical symptoms, the size of the prostate, the PSA density and velocity, other health conditons, whether or not there were any bumps felt on the DRE, how many cores were positive, and how much cancer was in each biopsy core.

Many of us who have had a prostate cancer diagnosis seek second opinions from radiologists and oncologists who specialize in prostate cancer. Second opinions obviously aren't free (my experience is that they cost anywhere from $500-$1500 each) but they are critical to gaining a full understanding of the scope of your husband's disease and the full range of options open to him for treatment.

A second opinion on the biopsy is also strongly encouraged as reading the Gleason score is a highly subjective process and other pathologists may have differeing opinions and I urge you to have your slides read by a leading pathology center such as Johns Hopkins or Bostwick Labs where they have specialists in recognizing prostate cancer patterns in biopsy slides.

At this point your husband needs to be educating himself on the various treatment options available to him, their potential side effects, and gaining an understanding on the progress of this disease and how it will affect his quality of life. You're fortunante to have (at least at this point) a less threatening diagnosis which affords you some time to research your options.

As you may know, the new health care law prohibits denial of coverage for pre-existing conditions so it may be useful to you to also start researching medical plans available from your husband's overseas employer or private insurance options. Some doctors offer steeply discounted services for patients with special financial needs but I'm afraid I can't offer you any suggestions on how to seek out such doctors and institutions.

It seems to me that the most prudent course is to conduct some research, gather second opinions, and figure out what the optimum treatment for your husband is and then figure out how you might pay for it. At this point I don't believe you should be making a decision entirely on cost alone.

If you do follow the advice of your urologist and pursue robotic surgery, please make sure you seek out a surgeon with a lot of experience. Many studies have shown that robotic surgeons do not gain proficiency in this procedure until hundreds of surgeries have been performed and patients with less experienced surgeons are much more likely to experience adverse side effects that will impact your husband's quality of life for decades.

Best wishes to you and your family for finding a suitable solution for your situation.

K

thank you very much for your kind and informative response. We are just getting started and we will consider everything you suggested very carefully. We wish you continued good health.