Insurance has denied coverage

pow1320
pow1320 Member Posts: 2
in Prostate Cancer #1
I am 52 years old I am a gleason score of 6, I chose surgery as I would like this cancer removed from my body as I have heard of people watch and wait and one of them has passed, he just waited to long I guess.

I had no insurance for 3 years after going into business for myself. My wife and I had been discussing putting me on her insurance (blue cross blue shield of Oklahoma. We did in April of 2011. May 6th of 2011 I was diagnosed with this cancer. Early this week I decided to have the surgery and called the doctor and put it all in motion, The surgery was set for July 14th, until today!!! I recieved a call from the nurse informing me that the insurance compny will not pay on pre exsisting conditions for a period of one year. How ever they did pay for the biopsy, well half of it anyway I had a 1,000 deductable plus another 100 plus dollars.

My question is does anyone know about any of the new laws that passed about this subject, I really honestly had no clue that I had cancer. Any advice?

Comments

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,346 Member
    #2
    I am not knowledgeable
    about the new laws, however, I am knowledgeable about Active Surveillance with Delayed Treatment for Prostate Cancer.

    It may very well be that you are a candidate for this treatment option, at least for one year depending additional information that you did not provide...number of cores taken, nomber positive, percent involvement of each core that is positive. ...your current PSA, and rate of change in your PSA's, and results of your Digital rectal exam .


    Active Surveilance for delayed treatment
    is a very viable treatment decision for low risk prostate cancer, since 97 percent of men with LRPC are likely to die of something other than prostate cancer. The pathologic stage of patients who are closely monitored, is similar to initally treated patients with LRPC, so the treatment decisions will be very similar. I've been doing Active Surveilance for the past two and a half years . I plan to continue with this treatment option for the rest of my life if I can. If not I feel that I will still be able to seek any necessary treatment. Feel free to click my name for additional detail.

    By the way, in case I require treatment in the future, I would like to consider a robotic surgeon in Oklahoma City.........are you in OK City?........can you recommend a surgeon?
  • pow1320
    pow1320 Member Posts: 2
    #3
    hopeful and optimistic said:

    I am not knowledgeable
    about the new laws, however, I am knowledgeable about Active Surveillance with Delayed Treatment for Prostate Cancer.

    It may very well be that you are a candidate for this treatment option, at least for one year depending additional information that you did not provide...number of cores taken, nomber positive, percent involvement of each core that is positive. ...your current PSA, and rate of change in your PSA's, and results of your Digital rectal exam .


    Active Surveilance for delayed treatment
    is a very viable treatment decision for low risk prostate cancer, since 97 percent of men with LRPC are likely to die of something other than prostate cancer. The pathologic stage of patients who are closely monitored, is similar to initally treated patients with LRPC, so the treatment decisions will be very similar. I've been doing Active Surveilance for the past two and a half years . I plan to continue with this treatment option for the rest of my life if I can. If not I feel that I will still be able to seek any necessary treatment. Feel free to click my name for additional detail.

    By the way, in case I require treatment in the future, I would like to consider a robotic surgeon in Oklahoma City.........are you in OK City?........can you recommend a surgeon?

    Good information
    Thank you for the post, that is enlightning information, I am in Tulsa and I believe I have a great surgeon his name is DR. Doyle.

    My PSA is 2.88, 12 cores taken, one core positive, 88% contained in the prostate and 11% on the outer portion.
  • Kongo
    Kongo Member Posts: 1,166 Member
    #4
    pow1320 said:

    Good information
    Thank you for the post, that is enlightning information, I am in Tulsa and I believe I have a great surgeon his name is DR. Doyle.

    My PSA is 2.88, 12 cores taken, one core positive, 88% contained in the prostate and 11% on the outer portion.

    Question
    Pow,

    How did you end up with a biopsy at age 52 with a PSA of only 2.8? Did the doctor find something suspicious on a DRE?

    K
  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,346 Member
    #5
    pow1320 said:

    Good information
    Thank you for the post, that is enlightning information, I am in Tulsa and I believe I have a great surgeon his name is DR. Doyle.

    My PSA is 2.88, 12 cores taken, one core positive, 88% contained in the prostate and 11% on the outer portion.

    National Comprehensive Cancer Network Guidelines for AS
    Disease stage , equal or less than t1c at diagnosis

    PSA density less than 0.15 ng/ml.

    Gleason score equal or less than 6

    Two or fewer biopsy cores with cancer

    No cores with more than 50% cancer
    ----------------------------------------------

    "one core positive, 88% contained in the prostate and 11% on the outer portion."

    I not sure what this means, hopefully another poster will provide information for you.
    ------------------------------------------------------

    Thanks for sharing information about Dr. Doyle. I googled his name. He attended a first rate med school. I wonder, how many surgeries has he done? Generally, a surgeon is practicing during the first 250; there is a steep learning curve.

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