Gary returns with an episode about receiving an insane EOB (Explanation of Benefits) from United HealthCare.

Today, it’s a rant, but I promise to make it a short tirade. The trigger? My latest EOB statement from my healthcare insurance company. To be honest, I seldom download and open these statements. I’m a big fan of Medicare and have a really good Advantage plan thanks to my late wife’s retirement program. Until this year, I have had the good fortune of being relatively healthy—no major illnesses or chronic medical issues. I typically incur few medical expenses, and it never costs me more than a small copayment for any procedure. My healthcare insurance company? UnitedHealthCare. Yes, the purported Darth Vader of the healthcare insurance evil empire.

On to my rant. So, I opened this new statement and was blown away by the year-to-date numbers it presented. The top line was enormous. My providers—the labs, imaging facilities, clinics, and doctors who delivered services—billed UnitedHealthcare over $256,000 from January to October. I know I was diagnosed and treated for prostate cancer, which isn’t cheap, but a quarter of a million dollars? I might add that I did not spend one night in a hospital or have an operation in a surgical facility. Now, the relevant numbers were the actual payments to the providers and my share of the costs. UnitedHealthCare paid a bit under $33,00, 13% of the billed amount. My out-of-pocket share was an incredibly small $521.

This begs the question about what kind of screwed-up system, knowingly and with a straight face, bills anywhere from five to eighty times the negotiated cost of a medical procedure? Every provider knew precisely what they would get paid by my Medicare insurance company before they submitted the claims. These are pre-authorized payments, yet they still billed these egregious amounts. Why did a urologist bill over $23,000 for a 15-minute, in-office procedure, knowing they would get paid $279?

As I noted, I have the good fortune to have a decent Medicare Advantage plan that pays for almost everything. My concern is for the poor patient who sees an enormous unpaid balance and wonders if they will be required to cover it. Sure, there’s a note in the EOB saying you should not be billed for the balance, followed by another notation that the patient may need to pay a copayment, coinsurance, or deductible. So, am I on the hook or not? No wonder there is so much anxiety today around medical treatment and its costs.

In my humble opinion, the medical-industrial complex of healthcare providers and insurance companies maintains this evil pricing charade to take advantage of the disadvantaged. These obscenely inflated prices are the starting point for unfortunate patients who may be underinsured or even uninsured. How many families have lost homes or gone bankrupt based on their inability to pay these fantastical prices?

Explaining the complexities of the healthcare payment system is way above my pay grade. Still, these thoroughly confusing payment practices can partially explain the anti-healthcare sentiment rampant in our country. And we haven’t even touched on the burden of self-advocacy placed on patients dealing with complex medical issues. Or the simple frustration of just trying to ask their healthcare provider a simple question. Leave a MyChart message? No response. Call the office? Listen to a long phone tree before being sent to voicemail. Leave a voicemail message? Ignored. As you can probably tell, I’ve dealt with a few challenges over the last nine months.

My tirade was triggered by a stunning Explanation of Benefits statement from UnitedHealthCa...

Gary decided his prostate cancer was not yet in the rearview mirror.

I know. I wrapped up the Prostate Papers project in the last episode. It was planned as the final episode of the series. I didn’t want to write about my prostate cancer any longer, and I’m sure you didn’t want to listen. After all, in my thinking, it was over. My cancer staging was encouraging (favorable intermediate risk), my state-of-the-art treatment was scheduled, and the long-term prognosis was excellent. I was optimistic. A couple of weeks in San Francisco for my radiation sessions, and it would be in my rearview mirror, disappearing into the past.

Well, it didn’t quite turn out that way. After returning home to Santa Fe, I debated for several weeks whether to leave the Prostate Papers project closed and on the shelf or record a new “final” episode. I’m not looking for sympathy, but I decided I wanted to be honest with my listeners, especially my new buddies in The Club, who graciously shared their prostate cancer experiences with me. So, one more chapter in the Prostate Papers, and it’s over. I think…who knows?

Anyway, what I discovered, even with all my research, is that prostate cancer lingers. It’s not “one and done” for most patients. My optimism and belief that I was in control masked the reality of most cancers. Even with successful treatment (surgery, radiation, or chemotherapy), a period of recovery can be long. And there are side effects. Boy, are there side effects!

I should have known this intimately. After all, my first wife underwent every treatment in the books for breast cancer. It was treat, recover, deal with the side effects, and then repeat. It was part of her life (our life) for seven years. I was denying reality, assuming my cancer was different.

It wasn’t. In my case, I was hit almost immediately after my last treatment with a serious, radiation-caused urinary tract obstruction. I now need to self-catheterize several times a day. It surprised me. Notwithstanding my over-the-top research, this treatment side effect never appeared on my radar. On a positive note, my radiation oncologist says it should diminish over the next few weeks or months. A couple of friends who experienced the same issue after their radiation treatment also reassured me that they recovered from this uncomfortable side effect. I’m guardedly optimistic, but patience is in order.

By the way, we haven’t even touched upon the well-known, long-term outcomes of radiation treatment for prostate cancer. These side effects can take months, even a year or longer, to show up. It’s become painfully clear to me that prostate cancer will always be part of my life.

So why am I reopening the Prostate Papers and sharing my post-treatment status? My primary motivation is an obligation I felt to guys who are dealing with their prostate cancer issues and who listened to, or might tune in to this podcast series. There are enough challenges and decisions in the diagnosis and treatment of prostate cancer that full disclosure of the potential side effects can be overlooked. It happened to me, and I did a ton of research throughout this journey. I thought I was well-informed but discovered I wasn’t. If this can help a few of my prostate cancer buddies avoid unpleasant surprises, it’s worth the effort.

So, my advice is simple. First, accept the fact that prostate cancer is now part of your life. You might be among the few lucky ones who complete their treatment with no short- or long-term side effects and never have a recurrence. That would be great but don’t assume it’s a given. Prostate cancer takes its toll on many of its victims.

Second, avoid nasty surprises by doi...

The wrap and final episode of The Prostate Papers. It's time to draw this story to a close.

Gary Ebersole here, back with the closing chapter of The Prostate Papers. You might have noticed the recent “dead air” from the Camp Codger podcast. I haven’t abandoned Camp Codger, but I couldn’t bring myself to deliver another long episode about prostate cancer. Sometimes, you can get too close to a topic, and this was one of those topics for me. Anyway, my personal experience with the scourge of prostate cancer has reached a significant juncture, and I feel a need for closure, hence this final episode of The Prostate Papers.

I went to Denver in early July for my biopsy, and the results came back a week later. To understand how I ended up 400 miles from Santa Fe, where I live, for this critical procedure, read my blog post on the biopsy dilemma. As you might expect, I hoped the pathology report would let me move into “watchful waiting” or even “active surveillance” mode. Unfortunately, the Denver urologist who performed the biopsy and did the cancer staging said that I needed treatment—surgery, radiation, or even focal therapy. He said it wasn’t urgent, but I did need to do something sooner (measured in a few months) rather than later (a year or two).

For the curious, I have chosen to undergo external beam radiation therapy using the SBRT protocol rather than have a radical prostatectomy via robotic-assisted laparoscopic surgery. What a mouthful! Anyway, the treatment will occur during the last two weeks of October in San Francisco. Yes, I’m also traveling out of state for my treatment. I explain my rationale for this decision in a blog post on CampCodger.com.

Let me leave you with a couple of closing comments. First, an important point to leave listeners with is that your level of involvement in your diagnosis and treatment is your choice. You can follow my over-the-top path and go into a research frenzy. It was perfect for a geek like me since understanding how things work matters. My immersion in the world of prostate cancer has led to the diagnostic choices I made. It also determined my treatment choice. That said, what works for me may not work for other guys. If you have an excellent urologist that you trust and a support system to give you wise counsel, the low-research approach can be the right path for you.

Second, for the guy or his family who must know as much as possible about the diagnosis and treatment of prostate cancer, do your online research, as I suggested in an earlier episode. Then check out Dr. Patrick Walsh's Guide to Surviving Prostate Cancer. This comprehensive book loads you up with detail, often more than you want. I was well-informed when I finished reading the book.

So, it’s a wrap for The Prostate Papers. Developing these episodes has been cathartic for me, but the interaction with my new “prostate buddies” in our special club has been even more amazing. Thanks, guys. It really made a difference.

Before we go, let me reassure our listeners that I am convinced everything will turn out well. My doctors and all the data I hav...