Cancer isn’t cheap.
I received the last of my Explanation of Benefits statements covering my salvage radiation therapy (SRT) with concurrent androgen deprivation therapy (ADT). You know me. For grins and giggles, I had to play with the numbers.
Ouch!
| Therapy | Billed |
| Radical Prostatectomy and post-surgery infection (January 2011) | $109,989 |
| Salvage Radiation Therapy (incl. 6-month Eligard dose) (May-August 2022) | $176,548 |
| Total | $286,737 |
Those numbers do not include all of the doctor visits and PSA tests from diagnosis to today—just the surgery and SRT/ADT.
For the radical prostatectomy and the subsequent infection hospitalization, that’s what the hospital and doctors billed my employer-provided health insurance company. Of course, the insurance company didn’t pay the hospital the full amount, and I had some copay responsibilities to the tune of $4,372 as well.
For the SRT/ADT, the “Billed” number is what USCD has billed the VA for my treatment. Each zapping session was billed at $3,894. (My radiation oncologist had no idea it was that expensive. As a university employee, he’s not involved in billing.) It appears that the VA is reimbursing UCSD at a rate of somewhere between 10% and 15% of the billed costs.
Coincidentally, I came across this article about the costs of ADT: It cost $38,398 for a single shot of a very old cancer drug. My Eligard shot was billed at $10,835. What a deal! <sarcasm font>
Of course, the emotional cost of cancer is incalculable.
Moral of the story: Don’t get sick without health insurance.
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Dan's Journey through Prostate Cancer 
That’s about right, my figures were Full charges=$ 352,059.00
Medicare deductions = $ 313,999.00
Medicare Paid= $ 36,296.00
My portion = $ 1,763.00
That’s for 39 EBRT treatments + 2, 3mo Lupron shots.
Thank God for Medicare!!!
Charles
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Wow. Yep. I start Medicare in January as a backup to my care through the VA.
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Thanks for sharing, Charles!
I’m glad I’m getting my care through the VA, but I’m also signing up for Medicare to start in January just in case my benefits at the VA change. (Interestingly, there’s a tiered eligibility system in place, and not all veterans are eligible for care.)
Be well!
Dan
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Holy Crap.
What happens to the 85% – 90% that Medicare does not pay? I had similar treatments as you in British Columbia and the entire amount is covered by our provincial medical plan for which monthly premiums were eliminated a couple of years ago. I have no idea what amount gets paid to the doctors and the BC Cancer Agency for the provision of the services.
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Hey Gary,
That’s one of life’s great mysteries with American healthcare. I’m not sure how that 85% is accounted for. I know that they haven’t come after me, and I think it’s just written off somehow. I could be wrong and, frankly, I’m not sure I really want to know how the sausage is made. I’m just thankful I’m getting my care through our Department of Veterans Affairs (VA). It’s the closest thing the U.S. has to a national healthcare system because, I rarely have any copays through them and, when I do, they’re pretty minimal.
All the best,
Dan
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The costs are irrational I feel. In India, for my father’s SRT, at one of the most expensive hospitals there (Max hospital New Delhi) charged $5k (for full treatment, not one session). The eligrad like injection (Degarelix) is $100 if you buy from pharmacy directly or $200 if you buy from hospital. I guess that’s why we saw a lot of medical tourists there at the hospital in India. In UK, privately for international patients is still only $22k for SRT, and $250 for Degarelix from pharmacy. Wish you well.
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Thanks, Abhishek!
You’re right. Our costs are irrational, and I wish we as a country could figure out a way to deal with them more effectively.
All the best,
Dan
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Wow! I remember a saying attributed to the Jewish community – it seems like a goodwill wish but has a sting in its tail. “may you make a fortune…………………, and spend it on doctors’ bills”.
You would need to make a fortune to afford doctors’ bills!
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Just came across this and wanted to add my own numbers and thoughts on Medicare – since this is the season of Medicare decision making and I’m thinking of changing mine.
In 2014, I was only 63 when I was diagnosed with prostate cancer so of course was on private insurance (lots of $$ for premiums and a big deductible but I forget how much). I imagine I had at least one biopsy on that plan and had considerable co-pay and out of pocket cost but not sure how much. Soon after I got on Medicare at 65 (the traditional variety with a supplemental ‘Medi-gap’ plan – I think at least one of my doctors wouldn’t accept an Advantage plan), my urologist told me I had to stop with Active Surveillance and decide how to proceed. I had an MRI and another biopsy and various appointments, and there was never a co-pay or other out of pocket cost. In July of 2016 I had the prostatectomy and the bill for the surgery and one night in the hospital came to $57 K. Six months later the urologist wanted me to go for salvage radiation and ADT (my PSA never got below .2 and kept rising). I think the radiation was $125 K (about 35 sessions) and the ADT injections (Lupron) were somewhere around $2500 each, a total of four or those. (Undetectable PSA ever since!) So, once I was on Medicare, all my cancer treatments cost *nothing* but the piddling Medicare deductible (~$200?) and the monthly supplemental premiums. All I can say is Thanks LBJ and the Democrats!
So now I’m left with paying the supplemental premiums, $167, and also a drug plan premium, $32. If I switched to an Advantage plan, which you can only change to in this annual 8 week window, I could get a plan with no premium at all, including some dental and vision benefits (limited, I think) AND drug coverage. Co-pays would only happen with a specialist. Very tempting. The only downside I’m aware of is that not all doctors want to deal with Advantage plans, even tho they might take traditional Medicare. I’ve got till Dec 7th to decide so research is high on my to-do list for the next couple weeks. Hope you have a lovely Thanksgiving.
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Hey Patrick,
Thanks for your thoughtful comment. I’m in the process of doing my initial Medicare enrollment (starts in January 2023).
I opted to go with the original Medicare plan and will, like you, supplement it with a Medigap and Part D policies. Given how much I travel (or want to travel), I felt like a Medicare Advantage plan wouldn’t suit me, as I’d be tied to a provider network around my home area. I didn’t want to get bounced by a Bison in Yellowstone and find out that, “Oh. Sorry, sir. You’re not in our network,” as I’m in the emergency room.
The other reason I stuck with original Medicare is that it can be extra difficult to get back on it if you choose a Medicare Advantage plan. Plus, as I understand it (and I am NOT an expert at all), if you become dissatisfied with one Medicare Advantage plan and try to switch to another during the annual open enrollment period, the new insurance company may scrutinize your pre-existing conditions and charge premiums accordingly. As a cancer patient, I just didn’t want to even think about being evaluated for pre-existing conditions.
Each of us have to make decisions based on our own health situations, financial position, and risk tolerance. What works for one won’t likely work for another.
On a related note, did you see that Mayo Clinic has stopped accepting patients on Medicare Advantage plans? It makes me wonder if other providers will fall into the same model.
https://www.medpagetoday.com/special-reports/exclusives/101320
Thanks again for your comment and good luck with your decision. Happy Thanksgiving!
Dan
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