Giving Me the Finger

For years, this was part of every male annual physical examination, to check for prostate swelling, which could indicate prostate cancer, or the more common and less worrisome but still uncomfortable ‘benign prostatic hyperplasia’.

Now I certainly have a few health issues, but the symptoms of BPH are not among them. So I can ignore all the ads for supplements to promote prostate health. But still it pays to be safe, so for years I bent over and let my GP do his thing. I think he was more nervous about it than I was. Much, much easier than dental implants.

But progress marches ahead, and at Adventist Health in Lodi the finger is a thing of the past. It has been replaced by something called a PSA test and is a standard part of the blood work for a routine male physical.

At least that was what I thought. For years I’ve had PSA tests and never been asked to pay extra for them. But when I went to the lab last week I was told that of the battery of blood tests my Medicare and supplemental would cover all of them, EXCEPT for the PSA. Apparently it was coded as ‘medically unnecessary’.

Now at least the receptionist was nice enough to inform me of this before they drew blood, and let me know that if I wanted the test it was going to cost me $150. So even if there was no finger involved, I would be getting the finger, metaphorically speaking.

What’s an uninformed and relatively prosperous patient to do? I said go ahead and do the test. We spend about 1/7th of our GDP on medical care, so what’s a few dollars more? It’s only about the cost of one tank of gas…

Now it does seem to me that screening for prostate cancer might actually be considered ‘medically necessary’. When I finally saw my doctor to discuss the labs and other matters, I asked him if there had been some coding error in ordering the test that meant I had to pay instead of the insurance company. He told me that up to age 65 the screening was medically necessary and insurance would pay. But once you turn age 65 new rules come into play, and if you are asymptomatic then the test isn’t necessary and if you want it anyway, open up the wallet.

If you think this doesn’t make a lot of sense, I would point out that when government bureaucrats and insurance company lobbyists get together over drinks very little good can come out of it. I wonder what other surprises lay in store as I begin my Medicare odyssey?