My PC Story and Cost Info for the Uninsured

[Murk]

At my 64 yearly physical, PSA levels started to rise some so my personal care physician suggested to monitor it quarterly. Six months later it breached the 4.0 level and I went off to see a Urologist.

I met with two to get their input and decided to go with Dr. P of Johns Hopkins (JHMI). So I went through more blood work, a MRI, Biopsy and a pelvic and a nuclear full body scan.

The Net Net was my Biopsy showed that out of 9 samples, I had adenocarcinoma with a Gleason score 5+5=10 in five of the samples! While the nuclear full body scan did not show any cancer spreading outside of my prostate, I wanted to move quickly.

After reviewing tons of info here and from all the corners of the globe, I decided on Robotic Assisted Prostatectomy. The post pathology report indicated that my cancer was contained to my Prostate. Now my next step is to have a PSA test and then regular follow ups gong forward to ensure it is in check.

I feel very good and things are returning to normal. Incontinence has vanished and experimenting with my love life. I feel blessed to have JHMI close by and cannot say enough good things about their staff and expertise.

BTW, I worked for my self thus had my own insurance. When Obama Health Care came to being, I was to wealthy for subsidies but struggled to justify the premiums. My Carefirst Blue Cross/ Shield health care plan within 2 years went from $155 a month to $1500 a month along with upping to a $6,500 Deductible!

So, I did the math and realized that I would be paying each year $18,000 in just Insurance and then pay another $6,500 before Insurance would kick in. After all this, the Insurance company would only pay between 50% - 67% of my medical expenses (if I conformed to their plan and accept what they say they’re going to cover or not). I elected to forgo Carefirst Blue Cross / Shield who has 80% of the market in my state and fly without a parachute. Additional advantages included getting rid of the nanny and making my own decisions that are right for me. BTW, most health care providers provide cash discounts, almost everything is negotiable.

The bad news besides facing some hefty bills if you have a serious problem is that negotiating can be unpleasant for some people. Also, a big lesson learned is you will not learn what pricing Insurance companies get, or even better, what the Government rate is with Medicare who gets the best pricing by far.

Paying your own way gives you freedom, flexibility but you must be mentally ready to negotiate. People buy insurance for peace of mind. The ruse is that if you have a serious complication, even with Insurance, you could still easily go broke! Tal here on the boards says that some treatment drugs could be $100,000, so will your insurance provider pay for all or some of these costs? Insurance is for peace of mind and enable you to get healthcare while your provider will be sending you still some hefty bills. This is all just my opinion based on what I experience firsthand.

In my case my total medical expenses (see below) were a total of almost $47,000. If I had Blue Cross / Blue Shield after the base deductibles they might pay up to 66.6% of the medical.

So $18,000 per year ($1,500 per month), then $6,500 deductible and then afterwards the Insurance company would decide if they will pay up to 66.6%

$ 46,838.83 Total Cost of PCA after Negotiations

$ 18,000.00 Yearly Insurance Cost

$ 6,500.00 Deductible

$ 26,865.66 Insurance coverage at the most 66.6%

$ 19,973.17 Thus, not covered by Insurance

So a big loss right? Nope, I gave up my health Insurance after the 2016 year. That is now 4 years so my savings should be calculated for 4 years not a given year (or $98,000). Yes, there were minor or basic primary care physician visits for health and colds but nothing serious.

Please note that I don’t have the cost that Doctors and hospitals negotiated with Carefirst ,Blue Cross / Blue Shield so these numbers are unknown. For me I was just fed up with Obama Care and the whole Insurance Industry and wanted out. It worked out for me but there are risks. I learned over the last few years that most people drop insurance because they can’t afford it. I did it because of the cost burden and I was fed up with insurance companies ripping me off and dictating to me how to take care of myself. I knew the risks but wanted the freedom and the potential for saving and not wasting good hard-earned money.

My PCA Time line and Costs.

$196.00 February 29th - Blood work for Dr. Plotsky Physical

$200.00 March 3rd - Physical with GP physical and advised to see a Specialist

$191.15 April 1st - Meeting with Hershey Medical Urology

$96.00 April 3rd - Advanced PSA LabCorp Test

$317.00 April 9th - JHMI Contact and Telemedicine call with Doctor

$733.00 May 3rd - Prostate MRI

$23.00 May 7th - Antibiotic Swab check

$11.71 May 18th Antibiotic from CVS

$2,938.00 June 11th -- 2nd Bill for Biopsy (Pathologist)

$105.00 July 22 Telemedicine visit with Dr. to discuss Prostate Cancer prognosis

$140.00 July 31 JHMI Requested preoperative visit & test with GP physical

$58.00 July 31 - Blood work requested by JHMI was taken as preoperative test

$1,479.00 May 28th - Biopsy

$8,382.00 June 26th - Cat Scan and Nuclear

$6,000.00 August 10th - Robotic Asstd. Prostatectomy

$3,050.00 August 10th - Anesthesiologist

$1,260.00 August 10th - Pathology and Report

$21,658.97 August 10th & 11th - Hospital Facilities (Trying to negotiate yet)

$46,838.83 Total

I go on Medicare November 1st so the gamble is over. I still despise the Insurance industry though…

[Tall_Allen]

Thanks for that interesting spreadsheet analysis. I have a question: with only 6 months to go before you qualified for Medicare, why didn't you just get a 6-month Lupron shot and wait until November to be treated? It would have been a LOT less expensive.

[Murk in reply to Tall_Allen]

Yeah tell me about it but Dr. Pavolovich at Hopkins said going on that even short term would make his job harder. It really made me think but I just did it. The great news is that no more incontinence and love life is almost normal. I just hope my PSA stays good now.

Tal, thank you and others for all that you do here on the boards

[cesces]

"My Carefirst Blue Cross/ Shield health care plan within 2 years went from $155 a month to $1500 a month along with upping to a $6,500 Deductible!"

Very interesting. I would expect that to happen going from one of those fake, no real coverage plans, to a real health plan.

There were lots of junk plans pre Obamacare that basically covered office visits, but not much in the way of serious illness. My favorite was Golden Rule. As soon as you had real bills, they would do a deep dive on your medical history, claim non-disclosure of a preexisting condition, then cut you off.

I was unaware that any Blue Cross plan sold fake health insurance.

Thankfully, it is much more difficult to sell fake health insurance now.

At $155 per month you basically never had any health insurance in the first place. It's just that you were unaware that you had no substantive coverage for anything serious.

You were always on self pay.

[6357axbz in reply to cesces]

This sounds like an accurate assessment cesces

[Murk in reply to cesces]

This policy came directly from Blue Cross / Blue Shield (BC/BS) of Maryland so it was not fake. I was 58 then so better pricing then 60 or higher. Plus many people started getting higher premiums at that time. What really pissed me off was BC/BS had the audacity to question my yearly health check up my last year with them LOL. IMO, they spend way to much time and money on administration and management fees, trying not pay...

[cesces in reply to Murk]

$155 per month is not enough premium to cover the actual cost of the insurance. Not even for an 18 year old.

BC/BS has excellent actuaries. They don't sell unprofitable lines of insurance.

Ergo... There were gaps in your coverage.

The reason your Obamacare insurance costs more is not a magic 10x increase in medical costs.

It was a magic 10x increase in catastrophic coverage.

I come from the industry. I know you never read your insurance contract. And if you attempted to, you would not be able to understand it.

BC/BS was giving you nothing for free. And the only you would ever learn what was not covered was after you submitted a catastrophic claim.

Look up Dunning Krueger syndrome on Wikipedia and then you will understand what I am talking about.

Obamacare made it illegal for insurance companies to play three card monte with insureds. That is why your insurance rates went up. They were no longer permitted to cheat you. So they had to raise their prices.

$155 a month health insurance is by definition hoax insurance.

Sorry.

No doubt you are used to being the smartest guy in the room. That's not so easy to do in this forum.

[Murk in reply to cesces]

LOL Thank you for this and hey I learned long time ago to assume and hope that I'm at least the second dumbest person in the room so that the 1st would be the patsie! I will say even at $155 per month they made money off me since I never went for healthcare except annual physical which they tried to push back.

I hope you got out of Insurance business. Now admit what percentage of the overall estimated costs of any given Insurance company came from over head managing and saying NO to prescribers? What discount percentage on pricing does Insurance companies get versus from Hospitals / healthcare in general and what does Medicare get?

I looked, You're right I went through CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. of Maryland which are independent licensees of the Blue Cross and Blue Shield Association in Maryland.

It was so much fun flipping them off LOL I have to admit!

[cesces]

By the way there are multiple services from whom you can get actual pricing information.

The problem is that many healthcare institutions (pretty much all of the best) are institutionally incapable of negotiating with a patient. At least not until the bill has been put into collection.

Also, a good idea... when they give you those long forms to sign, sign "I don't agree". The minimum wage drones taking your signature won't care, if they even notice.

[davebakerpurton]

Thank god for the NHS in the UK

[aceace12]

wow your very fortunate to be able to pay ....good luck

[MarkBC]

I don't know whether I pay more in taxes for universal Canadian health care than Americans pay for health insurance but I don't care if I do. I get great health care and I don't have to negotiate or endure any financial stress when I get sick or injured. It's worth it to me.