How much it costs for 40 radiation

Steve -- That's rough! I assume at 71 you are on Medicare. Do you have a supplemental insurance plan or a Medicare advantage plan? If you do check your health insurance plan to see if it has an annual maximum out-of-pocket. My BC/BC Medicare Advantage plan has a maximum out of pocket of $4,900 per year.

When I had my SRT 7 years ago my employer health plan had a maximum out of pocket of $2,500 or $3,000, which was all I paid even though the total was in the neighborhood of $70K.
Jim

Explore all the insurance you might have. Don't despair. Treatment will be paid for. Just get treatment.

Regular fraction radiation will of course cost more than surgery. Forty procedures versus one. But you need to find out what the reimbursement rate is. The radiation center can tell you that as can MEdicare. Call Medicare and get a determination. Do you have a supplement plan? That is important and you need to talk with your carrier on that.

I had two HDR fractions and 25 IMRT fractions for about $29,000. So be sure to look at reimbursement rates not what is charged. Two different things.

Makes me wonder. My 28 IMRT and everything associated with it was $155,000. With BCBS I paid $900 out of pocket. Pretty wide spread.

It is early in the year so you might not want to wait, but....
You might want to check your current Medicare coverage. If, for example, you are currently paying low to no monthly premiums the odds are you have higher deductibles, lower reimbursement rates and higher out of pocket expenses.
Since you can revise your Medicare coverage every year you might consider a higher monthly premium to get a lower deductibles, and higher reimbursement rates. It's not often that people know large medical expenses are in theiIf it were me I'd pr future. Use that to your advantage.

On the other hand it is February and your PSA is rising. If it were me I'd say screw the cost and just do it.

Good luck to you.
Jeff

I have a Medicare Advantage plan...UHC,,,,my 45 fractions of Rads I think were 155K....downed to 28K....my out of pocket was $6700 ....still dealing with ins. to get back some $$ from deductables payed after the max OOP was paid ...a real PITA ......David

steveo

(1) Ignore the people telling you to call Medicare and ask what they pay for a type of care. Medicare will not tell you anything and just tell you to call the provider's billing office and ask them.

Now the question is what the $70,000 is. Is it the Chargemaster rate (sticker price) or is it the amount that Medicare will let them charge?

You do need to call the provider's billing office and ask them - very specifically - what you copay is in $$$$ for each treatment when you have Medicare coverage . Do not let them fob you off with "oh it is 20%". Make them give you a number. Make them put it in writing and email it to you.

(2) Ignore the people telling you that you need to get an Advantage plan - for 2 reasons.

* You can not change coverage until late this year (Oct-Dec) and any changes will not go into effect until Jan 2018.

* Advantage plans have fixed dollar copays - $50 here, $175 there etc. WITHOUT fail the fixed dollar copays are higher than what 20% would be. It would be rare that the 20% would exceed the max out-of-pockets of an Advantage plan (typically $9000 in this state.)


A Medigap supplemental plan is much better than an Advantage plan BUT you can not get one into effect until Jan 2018 -- and even then insurers can refuse to sell to you if you have health problems and didn't buy one when you first enrolled in Medicare. Medigaps come in different levels - basic pays the copays but not the deductibles and the most expansive (and expensive) pays everything Medicare does not.

(3) If your household income is low enough, you might qualify for Medicaid in addition to Medicare as a dual eligible. Medicaid would pay the Medicare B premiums, deductibles and copays.

It is around 135% of Federal Poverty Level - FPL varies depending upon how many in your household.

(4) Talk to the medical facility billing office - they may have some type of patient assistance.


Have to say that $1750 per treatment probably isn't that far off. It could be what Medicare allows them to charge and Medicare pays 80% and you pay 20%. Radiation is an expensive treatment (equipment, facilities etc) and that is less the Medicare paid in a facilities fee for the outpatient surgery clinic for my broken wrist - just the facility, not the surgeon or anesthesia.

You might try for SBRT. 5 treatments in 1 week. Similar positive outcomes to IMRT and other radiation treatments.

I was told by Winthrop / Cyberknife that in their experience, Medicare would not pay if I had a high risk Gleason #. They do pay for low to intermediate. On the other hand, Winthrop said that my maximum out of pocket to them would be $5000.

Great news. Have your congressman, senator and President Trump on speed-dial and make sure the paperwork goes through better than last time. Don't be shy as you deserve the best.

Thanks for your service and best wishes for effective treatment.

34 sessions, insurance was billed $196K. We paid our max deductible of like $4K