2024 list of Medicare PCa approved treatments.

Arthurdent
Arthurdent Member Posts: 14 Member
edited March 11 in Prostate Cancer #1

I am getting my transperineally fusion targeted biopsy at the end of the month. I have been trying to prepare for treatment options from AS to surgery and all points in between. Keeping busy keeps my anxiety well-directed!

71 y.o. with an Advantage plan. My first option would be to remain fiscally efficient and start with Medicare-approved options currently offered. Then search providers if necessary.

I am having difficulty getting a list of the 2024 options for 1st-time treatments Medicare approved. Has anyone been able to pierce this veil?

An inquiry to Quartz, my Advantage provider, has been less than stellar. Their response was to provide them with the codes of the treatment options and then they can respond. Quizzing all the providers within my network seems to be a daunting task!

Any way to solve this riddle?

Thank you,

John

Comments

  • Arthurdent
    Arthurdent Member Posts: 14 Member
    #2

    ANYONE?

  • Forherself
    Forherself Member Posts: 1,013 Member
    edited March 10 #3

    Visiting from the endometrial cancer page. Your question is really about insurance. When I was diagnosed I had an Advantage plan. I was not able to find a doctor in my city to do a biopsy for 4 months! Advantage plans are preferred provider organizations. They contract with Medicare. SO you are contracted with your insurer. I changed to Supplemental insurance during the time when I could (Oct). Supplemental plans allow you to use any provider or clinic. I suspect you are just going to have to deal with that Quartz and find out who contracts with them. Be persistent. It can be frustrating. The codes can be obtained from the office that is doing the biopsy

  • Wheel
    Wheel Member Posts: 143 Member
    #4

    I learned if you just Google Medicare and covering the procedure it will usually come up with something from Medicare about whether it does. You can also ask for the codes, but once you know Medicare covers it you should be good to go. It seems like Medicare covers all the initial front line treatment’s, except for like proton treatments and the newer ones like Tulsa, but I believe it also covers HIFU. It just might be difficult to find a Doctor in your network that might be very proficient with certain procedures.

  • Josephg
    Josephg Member Posts: 455 Member
    #5
    https://csn.cancer.org/discussion/comment/1713861#Comment_1713861

    Very true, regarding Medicare treatment protocol eligibility.

    However, the potential issue with Medicare Advantage programs is that you may not be free to select the specific treatment facility and/or doctor that you want, as they may not be included in that the specific network.

  • Arthurdent
    Arthurdent Member Posts: 14 Member
    #6

    yes. My first choice clinic for biopsy offered only transrectal. I was lucky to find a great center that offered a transperineal in-network.


    My transperineally center also offers HiFU if my biopsy is qualified. fingers crossed.

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