To start out, here is some advice we received from a very respected doctor in the TC field:

"The first thing is don't ignore it just because you don't have insurance. Remember early stage testis cancer is a whole lot cheaper to take care of than late stage testis cancer. Second, an exam by a physician shouldn't cost too much. You also can negotiate a payment schedule with most physicians, and remember, most people with testis cancer symptoms do not have testis cancer. Thirdly, there is almost always health care access through public hospitals, county clinics, VAs for vets etc. You can always call the county health office and they can direct you."

Doug's comments:

* If you are in an HMO, you may have a hard time getting a second opinion from a doctor outside of the HMO (or PPO). Talk to your primary care physician and urologist/oncologist about this. My doctors told the HMO people that no one inside the network had anything intelligent to add with regard to a second opinion. They insisted that the HMO pay for me to get a second opinion from Indiana University. That second opinion did not cost that much and probably saved the insurance company a lot of money in the long run.

* A pathology second opinion doesn't cost that much. If the insurance wont pay for it, do it yourself.

* Do not assume that traveling out of town for treatment is financially impossible. It is often both cheaper and medically superior to be treated at a center of excellence. This is particularly true for major surgery when no one in your area has experience doing the procedure.

* A lot of insurance plans have a yearly maximum out of pocket allowance. When I went through this it was $2500 + deductible. If this is true for you, and you also have a plan that pays 80% in network but only 50% out of network, then don't worry about it. If you have RPLND or Chemo, then you'll hit the maximum either way so go wherever the care is best.

Bruce sent in this HMO advice:

1. Be thoroughly familiar with the text of your existing policy coverage. Make sure you have *all* supplemental materials.

2. Keep a log by the phone; always note date and time of call and general gist of what was said.

3. ALWAYS get the names, both first and last, and the direct phone line of all persons with whom you talk.

4. Be respectful to receptionists, but always ask to speak to someone who is empowered to make a decision.

5. Request the names of ALL persons involved in the decision, including any so-called "medical advisors".

6. Demand all decision in writing, with full and official explanations of definitions (e.g., of terms like "experimental").

7. If you are covered by a union, immediately contact your union benefits person. In our union (an affiliate of AFT) at least, the benefits person had multiple experiences dealing with insurance problems.

8. Obtain the name(s), address, and phone numbers of any regulatory agencies or professional organizations that have jurisdiction over HMO's in your area.

9. Inform the HMO that you are going to your union and will not hesitate to contact public officials and the regulatory agencies that may have jurisdiction over them. It was emphasized to me that, as HMO's become more and more competitive, the prospect of "bad PR" is something they wish to avoid like the plague. Unions (and employers) contract with health providers, and HMO's do not wish to lose these large volume accounts.

10. Identify the appropriate person in the business office of your local doctor or treatment center. Work closely with that person. It is in their interest to work with you.

11. HMO's are used to passive consumers. Be as proactive as you can, as your time and strength allow. If possible, assign "insurance duty" to a feisty support person! My spouse was a very effective "bad guy". (It also allowed him to feel that he was participating in the overall strategy...)