Prostate surgery to the rescue
Take drugs or have an operation? I chose the latter, writes John Austin.
The gap fee and who pays what
Working out who pays what for a hospital operation can be daunting. Simply, don't rely on private health insurance to pay anything like the bulk of the cost of the procedure or operation.
Of the nearly $4,000 I was charged by the surgeon, my insurer contributed less than $300. While this may appear meagre, the insurance customer rep explained to me over the phone, “Health insurance should be renamed ‘hospital accommodation insurance'.”
Why? Because it is all about defraying the cost of the hospital stay, not the surgery. After four nights in hospital, I paid just $500 – which is the excess I choose to pay to bring down the cost of the premium. Not too shabby.
The surgeon’s bill was nearly $4,000, which is way more than the $1,187.20 recommended by Medicare.
Specialists have long said they have to charge more than the rebate to keep their businesses going and reflect their skill level. When Medicare chipped in with $1,187.20, I was left an out-of-pocket cost of $2,807 minus the $300 paid by the insurer.
My anesthetist cost nearly $1,300 – insurance does not pay for this. But I ended up with the out-of-pocket cost of just $500. That was a pleasant surprise. The insurance officer explained that my anesthetist probably participated in the Access Gap Scheme, which is administered by the Australian Health Service Alliance on behalf of its participating health funds.
In the end, I was satisfied that the hospital, surgeon, anesthetist and insurer were not ripping me off (too much?).
Related reading: Claims we’re being ripped off by specialists
Prostate cancer quite rightly has grabbed the health headlines but there’s another prostate condition that can diminish a man’s independence, confidence and mobility – literally turning life’s high tide of retired joy into a mere trickle.
Benign prostate enlargement is common – about one in two men aged over 50 will have some prostate enlargement. It can get bigger as you get older. It’s called “benign prostatic enlargement” or “benign prostatic hypertrophy” – non-cancerous but able to block the flow of urine and all the bad that brings with it.
The prostate is a walnut-sized gland that sits below the bladder. It surrounds the top part of your urethra — the tube that carries urine out of a man’s body through the opening at the end of the penis.
Its most important function is the production of a fluid that, together with sperm cells from the testicles and fluids from other glands, makes up semen.
The muscles of the prostate also ensure that the semen is forcefully pressed into the urethra and then expelled outwards during ejaculation.
As with many health-related conditions, as we age what seems to be a commendable bit of anatomy can go off the rails.
Why? Doctors aren’t sure. It may be connected to changes in your hormone levels as you get older. The male hormone testosterone can affect the prostate and enlarge it.
Your risk is higher if you:
- Are living with obesity
- Have been diagnosed with metabolic syndrome, diabetes, or high blood pressure
Don’t eat enough fruit and vegetables
Have a family history of it.
Up until recently, treatment was limited to changing lifestyle, often less-than-effective drugs, and padded underpants.
An enlarged prostate needs careful lifestyle management, and there have been men known to drive around with empty water bottles, and carry toilet rolls in their hip pocket – just in case the inconsistent urgency of needing to wee gets too much.
And flying. I suggest the benign enlarged prostate has swollen airline profits with passengers more than willing to pay the outrageously dearer price for an aisle seat, preferably close to the few toilets found on most aircraft.
Operating on the prostate was once seen as risky. Some years ago, a urologist ruled it out for me. But microsurgery changed that, and as we know even King Charles recently gave the op a thumbs up and appears to have recovered well.
I recently had a transurethral resection of the prostate or TURP. My current urologist is a big fan of the procedure and during my initial consultation, he explained it in minute detail. I crossed my legs.
There will be blood. Yes. Recovery can be up to six months and during the first few weeks, patients experience their stream, as weak as it may be, turning from clear/yellow to cranberry, he advised. Ouch, I thought.
The alternative was for the prostate to get larger, and my lifestyle thinner. I could stay on the current medication, which I was advised was increasingly subject to evidence that found prolonged use was linked to cognitive decline.
If it was good enough for the king, then it was good enough for me.
I booked in and prepared for the ordeal by ruminating about it during a pre-planned cruise down the Mekong and a multi-day hike along a Japanese pilgrimage trail. A bit of Japanese forest-bathing-Shinto-Buddhism emersion couldn’t be a bad thing.
The looming op lingered in the back of my head – what had I done agreeing to this? A near catastrophic incident in the onsen of a traditional Japanese inn convinced me to proceed with the procedure.
Tips to reduce out-of-pocket costs
Do your homework.
Information about choosing a specialist is available here. Remember you don’t have to go with your GP’s referral.
Before the surgery get an estimate of all costs from the GP, surgeon and anesthetist in writing.
Find out if medical specialists participate in the Access Gap Scheme.
I was surprised with this tip offered by my insurance officer: armed with what you've found out and your own needs, don't be afraid to negotiate a discounted price with the specialist. Afterall, she said, it is an unregulated and competitive market, so take advantage of it.
She also suggested, for the consultation, to “maybe take a basket of fresh baked goods”.
Forty-five minutes after a jolly hello from the surgeon and giving myself over to the anesthetist, I was awake, if groggy.
I had a catheter with a clear plastic bag attached, and for two days I never visited the toilet. I loved that, but all good things come to an end. The nurses were great, but I could have done without their regular reminder that at 6am the next day the tubes and everything else that had been connected, and inserted, would be removed.
I tried to cross my legs but it was time for the bag to be emptied and I just avoided another ballooning catastrophic moment.
A few days later I was back at work, continuing to produce cranberry juice, if much pinker than blood red, and taking alkaline enriched powder to reduce the pain of urinating.
No more antibiotics but Movicol (a gentle constipation treatment) continues to be my best friend – not to mention the rather dainty but hopefully sturdy nappy lined undies that provide a confidence-boosting safety net.
The good news is that as my recovery proceeds, there are a few more weeks of my wife driving me everywhere and being wonderfully attentive.
Disclaimer: This is not medical advice. Consult a suitably qualified specialist to determine whether this or any other procedure or course of treatment is suitable for you.
