Going forward with the operation

Well, I am on for the Institut Montsouris. It just looks like the best option. There are some excellent possiblities in the U.S., but all indications are that Montsouris is a master of the laproscopic radical prostatectomy. Its outcomes really look good, and my insurer appears to be ready to reimburse for this treatment. We will have to come up with the initial funds and then apply for reimbursement.

The financial side of this business is a bit obscure. There are two big factors that I see:

• Providers do not want to divulge much about the costs until they know that all they have to do is bill you. No one wants to dicker. The patient really does not want to, because what he cares most about is getting well. The medical providers do not want to talk too much because they do not want to get into a situation of competition or bargaining because of the second reason.
• American (and probably overseas) insurers whittle away at the costs, imposing "customary and reasonable" billing expectations that only doctors, hospitals and their business managers are likely to see. I have no idea what that does to the real cost profile, but I am sure that there are some major variations in the final costs from operation to operation that have nothing to do with the degree of difficulty or outcomes.

I have had one excellent doctor indicate that I should communicate my insurance information and let him tell me how much out-of-pocket I can expect. Now that's a fine entrepreneurial proposal. Others were more forthright with a number, but it either took a lot of digging or I had to tell the provider that I was looking for a lump-sum number on the basis of coming to their center from overseas.

I am going to do a separate entry devoted to costs that I will update as this thing plays out.