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Mighty pricey, this Prostate Cancer stuff.

Prostate Cancer | Last Active: Nov 1 10:28am | Replies (41)

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Profile picture for northoftheborder @northoftheborder

I've seen a lot of positive comments here in the forum about Medicare Advantage (part C). The other night, I started watching a piece from John Oliver's show that presented a very different view, including inflated billings to government (which wouldn't affect patients) and problems getting pre-approvals or finding doctors in-network (which would).

I haven't finished watching it yet, so there might be more, but I'd be interested in hearing from American forum members, especially those who watched the piece. How well did it align with your own experience? With Medicare Advantage, have you personally had significant delays getting pre-approvals for your cancer care, or trouble with doctors (and hospitals) moving in and out of network? Or are those issues that affect only a small minority of participants?

p.s. Yes, I know about John Oliver's political alignment, and am making allowances for that.

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Replies to "I've seen a lot of positive comments here in the forum about Medicare Advantage (part C)...."

@northoftheborder I have not seen the program you mention, but I turned 65 last January and went on Medicare. In the months prior to that as I researched the various options it became clear from various reports that Medicare Advantage plans were just like most (all?) health insurance plans, less expensive and great if you're not sick. But if you actually need to use the plans you fall into the same problems with private insurance: limited provider network, having to get referrals for specialists, having to get pre-approvals for most procedures and then the possibility of denials. A year prior I may have been tempted by the considerably lower rates, but with a Pca already having been diagnosed and researching treatment options I decided traditional Medicare with the best medigap policy was the only option: very low deductible, go to the doctor of my choice (almost everywhere accepts traditional Medicare, not so with Advantage), and great coverage. I went through 28 proton treatments, and with everything that was involved with that my total bill was approximately zero ($94.08). I did have a $2,000 deductible for the Orgovyx, but that was it. I know that the billing was hundreds of thousands of dollars, as discussed earlier in the this thread.