Vacuum Pump and Insurance

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Kark60
Regular Member


Date Joined Jun 2008
Total Posts : 91
   Posted 1/7/2009 11:50 PM (GMT -6)   
I still am having problems with ED post-RRP. I've been trying the oral medications and MUSE. The orals provide a bit more length and thickness, but nothing "usable." MUSE worked once, but not the second time. I called the uro's office and spoke with a nurse about getting a pump. She said the doc was willing to issue the order. However, the insurance company rejected the claim.

Is it typical that an insurance company will see this as not "medically necessary"? I'm wondering about other's experiences with this. Thanks...
Husband and father of two (current ages 5 and 7).
Age when diagnosed: 47 (currently 48)
Biopsy showed cancer only on left side.
Pre-surgery PSA: 13.7
Pre-surgery Gleason: 4+3=7
Pre-surgery Staging: T2
CT Scan, Bone Scan, PET Scan: Clear
Robotic Surgery on May 28, 2008, at Barnes Hospital in St. Louis.
Right nerve bundle spared; left bundle removed.
Catheter for 8 days with infrequent "stress" leaking. Pad-free after five weeks.
Continuing ED: attempted Viagra, Levitra, and Cialis with no response. However, had SUCCESS in October 2008 using MUSE.
POST-SURGERY PATH REPORT:
Bad news-
Gleason: 4+3=7
Involved 10% of prostate; all quadrants involved
Extraprostatic extension at left base and apex
Extensive perineurual invasion present.
Non-neoplastic prostate shows PIN, high grade, diffuse.
T3a
However, good news-
Bladder neck, lymphvasular space, seminal vesicles, 17 examined lymph nodes, and all margins are FREE of tumor.
Four-week post-surgical PSA = 0.1
Seven-week post-surgical PSA = .01
October 2008 PSA = 0.0
Next PSA scheduled for January 2009.


Sam Benton
Regular Member


Date Joined Dec 2008
Total Posts : 35
   Posted 1/8/2009 3:39 AM (GMT -6)   
My insurance covered my pump. I got mine right after the cath came out and by then I had met my out of pocket so it paid 100%. Did you call and ask them? It may have been submitted incorrectly.

Sam

Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4833
   Posted 1/8/2009 6:41 AM (GMT -6)   
I met the pump sales rep at my surgeons office. He mentioned that if you file a claim for penis pump, it'll get denied...If you file a claim for Medical Device #xxxxx  it has a much better chance of being covered.
 
United Health Care covered mine..
Age 53   - 5'11"   205lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Gleason - 6
(biopsy done March 4, 2008-> 2 of 12)
 
06/25/08 - Da Vinci robotic laparoscopy
10/03/08 - 1st Quarter PSA -> less then .01
 

Surgeon - Keith A. Waguespack, M.D.

Las Colinas and Plano Offices

 


jrponalameda
Regular Member


Date Joined Dec 2007
Total Posts : 56
   Posted 1/8/2009 8:13 AM (GMT -6)   
My sexual health specialist recommended a specific pump model, but warned me that insurance coverage could be an issue, so I called my HMO (Healthpartners) first. They were unwilling to cover the model my doctor had recommended because it was battery operated, but they would (mostly) cover an alternate manual model. So I switched to the model they were willing to give me coverage for (which ironically was the same price). It works fine. So check with your insurance and mention it's for post surgery therapy to see if they have any coverage possibilities.

Diagnosed Sep 2007 Age 54 Gleason 6 (3+3)
DaVinci Surgery 11/8/07 University of Minnesota
2/22/08, 8/15/08 PSA Undetectable

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