Most insurance carriers, whether they are private or government funded, may expect prostate surgery candidates to meet certain requirements before agreeing to cover the procedure. There are several reasons for these requirements, from the rising cost of medical care to simply wanting to be sure that all avenues have been covered before encouraging invasive surgery.
While prostate surgery is a highly effective treatment and necessary for many men suffering from prostate cancer, prostate surgery for other prostate problems, such as an enlarged prostate, may be considered unnecessary for some men under certain conditions. First, it should be remembered that not only is an enlarged prostate a normal part of growing older, it is also not considered to be a life threatening condition. Unless candidates for this surgery can meet certain requirements, their insurance carriers may be hesitant to cover the procedure.
The first requirement most insurance carriers will require is clear documentation of the condition. Candidates should have no problem coming up with this requirement, as their doctors should be keeping detailed documentation of the progression of the condition. As it is the doctor who usually suggests the procedure, he should be able to back up his reasoning with paperwork.
The other requirement many insurance carriers will expect is that the candidate and doctor should be able to show that other alternatives have been explored before consenting to invasive surgery. This is not only to avoid an expensive procedure when it can be avoided, but also to take the risks of any surgery into consideration.
Research has shown that non-invasive techniques such as following a well balanced diet and taking certain supplements, such as saw palmetto, can help reduce prostate problems and even prevent them altogether. Some insurance carriers may wish to see that these alternatives have been attempted before consenting to surgery.
Those that are covered through Australian Medicare may have an advantage over those covered by private insurers financially but may have to give up control in other areas.
While procuring the consent of the insurance carrier is always important, candidates should also know exact what their carrier will cover and what they will be left to pay for themselves. Those that have private insurance are strongly recommended to contact their insurance carriers to learn what their individual plans will cover and what they will be expected to pay for, including the length of hospital stay, medications, and follow up visits.
Those that are covered through Australian Medicare may have an advantage over those covered by private insurers financially but may have to give up control in other areas. While it is clear that going into the hospital as a public patient can reduce greatly the amount of financial burden he will be expected to carry , he may not be able to choose his own doctor. He may also have to pay for certain medications out of his own pocket.
Understanding what your insurance provider will expect before consenting to prostate surgery is a very important part of the process. Do everything you can to meet your insurance carrier’s requirements and be prepared for anything that you will be responsible for, and you will be better able to recover from your prostate surgery with peace of mind.
