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Newly diagnosed Metastatic Prostate Cancer

Prostate Cancer | Last Active: Nov 10 9:33pm | Replies (22)

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@rxgolfer

Thanks, I used to have Humana, but get better dental and other perks with UHC. Going back to orig. Medicare is on the table, don’t know if I want to wait til Jan 1st for it to go into effect.
My UHC plan pays for out of state services supposedly if at an in network provider. Just jumping through hoops to see if I can get an appt. With Dr I want.

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Replies to "Thanks, I used to have Humana, but get better dental and other perks with UHC. Going..."

I have considered going back to regular medicare. My agent told me that can be done on the first of any month, you do not need open enrollment. My wife has been to MAYO Phoenix. Incredible place.

Hi @rxgolfer , I am a layman, 68 with Gleason 8 PCa. I am going the treatment route of proton beam radiation treatment + hormone therapy. I had trouble getting to see the doctor I wanted due to my Medicare Advantage plan here in MN. Checked out switching to Original Medicare. Regarding getting a supplemental policy, I recently checked with UHC, Blue Cross, Humana, Cigna, and HealthPartners. Since I am outside the "guaranteed right of issue" period during which you don't have to undergo underwriting for a supplemental policy, I was denied coverage at all of the above insurers. Need to be cancer free 2 - 5 years to get coverage they said.

You could risk Original Medicare without a supplemental plan but take on the risk of paying 20% part B coinsurance, and the risk of no cap on out of pocket expenses. Then you could switch back to Medicare Advantage at a later date. (Also, there is never any underwriting involved if you switch back from Original Medicare to Medicare Advantage.)

My digging also uncovered the following. It appears to me, due to state law, if you lived in NY or CT you could not be denied a supplemental policy. Also, a radical idea to get a supplemental policy would to be to move from OK to any other state, in which case you would be guaranteed an Original Medicare supplemental plan without underwriting.

Regarding getting a referral to Mayo Phoenix from your physician, you have nothing to lose, they may very well accept you despite your insurance. (I recently got my Medicare Advantage denial of coverage overturned via an appeal from my radiation oncologist's insurance team.) While waiting on Mayo's decision you can go forward with lining up an appointment with another doctor or doctors of your choice. Best to line up appointments ASAP because you will probably have weeks of lead time to the actual appointment. You can probably do telehealth consults to avoid traveling, initially.

One other point, if you choose radiation therapy you will probably need hormone therapy as well. My doctor started me on hormone therapy right away (Orgovyx). I am guessing your doctor, once you find one, will want you to start hormone therapy right away while working through your insurance situation.

Best of luck to you. Keep reaching out to this group with your questions / problems. There are many members here with lots of knowledge and personal experience!

Someone on here mentioned at one point that Mayo Rochester may not have the same requirements for Medicare advantage. That might be a little more of a trip but it would be better than out of pocket expense.