Anybody Insurance refuses to pay or has Paid for Da Vinci Help?

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56pontiac
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Date Joined Sep 2006
Total Posts : 230
   Posted 9/25/2006 12:03 PM (GMT -7)   
My insurance company Lifewise of Oregon says they will not pay for the Robotic assisted surgery but will pay for the regular surgery. They say it is experimental. If you have had a similar problem ot if your comapny paid not problem please give me the name of your company. I am trying to prove to these people it is not experimental anymore.

spinbiscuit
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Date Joined Apr 2006
Total Posts : 818
   Posted 9/25/2006 1:19 PM (GMT -7)   
UnitedHealthcare covered the DaVinci procedure for me on 2/23/06. You can Google their web sight to confirm.

Glen

Swimom
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Date Joined Apr 2006
Total Posts : 1732
   Posted 9/25/2006 6:55 PM (GMT -7)   
56,

Kaiser is giving people a hard time too darnit-all. Keep up the fight.
Do they pay for a LRP's or just an open? It's the same minus the robot.

Good Luck, Swim

56pontiac
Regular Member


Date Joined Sep 2006
Total Posts : 230
   Posted 9/25/2006 8:01 PM (GMT -7)   
They pay for LRPs it is they robot they are saying is experimental.

Swimom
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Date Joined Apr 2006
Total Posts : 1732
   Posted 9/26/2006 9:18 AM (GMT -7)   
Go for a good surgeon who has done a boat load of laps then! Laps are harder to master than the robot assist so get a great surgeon. Other than that, the cath, results and healing time are alike.

56pontiac
Regular Member


Date Joined Sep 2006
Total Posts : 230
   Posted 9/26/2006 10:15 AM (GMT -7)   
If I have to I'll pay the difference for now. It appears it is less than $1700.00. I just don't get it. I wouild be in the hospital at least two days with the other and less than 23 hours with the robot. How much is an extra day in the hospital that should offset any additional cost for the robot. The insurance company is still working on it. We have to go through their little grievance process before I go to the Insurance division.

GreenAcres
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Date Joined Jul 2006
Total Posts : 474
   Posted 9/26/2006 10:39 AM (GMT -7)   
Hi, 56. If it's any help, Medicare approves daVinci and you know they're probably not going to go for anything that's considered "experimental."

spinbiscuit
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Date Joined Apr 2006
Total Posts : 818
   Posted 9/26/2006 4:07 PM (GMT -7)   
Hi 56pontiac,

I hope that your insurance company comes to the obvious conclusion that DaVinci procedures will save them expensive days of recuperation time in the hospital. However if that is not the case then as Swimom suggest a highly skilled and experienced lap doctor will acheive the same results, and the healing will be just as quick.

I have to ask this: Do you have a 56' Pontiac Chieftain with the hood emblem that illuminates?

Glen

56pontiac
Regular Member


Date Joined Sep 2006
Total Posts : 230
   Posted 9/26/2006 5:21 PM (GMT -7)   
Yes I do have a 56 Pontiac Catalina Chieftan Red and Black Fender Skirts Sunvisor Contenental kit Lighted Hood Ornament. You might get a hoot out of my band 56 Pontiac. I'm the old guy with rotten prostate my son is the "tall drink of water" and plays the slap bass http://www.myspace.com/56pontiac It appears the insurance is going to pay at least the money for a LPR. I haven't got it in writing yet.
.

spinbiscuit
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Date Joined Apr 2006
Total Posts : 818
   Posted 9/26/2006 6:29 PM (GMT -7)   
That is good news, ya gotta stick-up for what is right. I hope they send you that letter asap.

My Dad had a 54' Pontiac Wagon with a straight 8. We went cross country to California in that wagon, and through a couple of deserts too. As I recall even at 70 mph with no a/c crossing the desert was pretty miserable. I've got a vivid picture in my mind of exactly what your 56' looks like, and I think I can remember the sound of that big 8. I'm looking forward to hearing and seeing your band too.

So keep us posted when ever you can, and good luck with that insurance company.

Glen

56pontiac
Regular Member


Date Joined Sep 2006
Total Posts : 230
   Posted 9/26/2006 8:05 PM (GMT -7)   
If you have never drank water form a canvas Desert Cooler water bag hanging on the front of a 50's cruiser in the middle of the desert on Route 66 in July you just ain't lived.

Wicket
Regular Member


Date Joined Aug 2006
Total Posts : 316
   Posted 9/26/2006 9:28 PM (GMT -7)   
I've drank water from a canvas Desert Cooler water cooler when we moved from NY to So Calif and drove across country. I can remember that like it was yesterday and it was many eons ago when I was 11. Wasn't in a 50's cruiser though...was a 54 Studabaker!!!
Ellen
 
 
Curtis, 63,  Diagnosed Aug 21, 2006
T1C
Gleason 3+3=6, 3+4=7
PSA 4.10
 
Bone Scan Negative!!
DiVinci surgery scheduled for October 10th


spinbiscuit
Veteran Member


Date Joined Apr 2006
Total Posts : 818
   Posted 9/27/2006 7:19 AM (GMT -7)   
Yes indeed! I do recall the design of that bag was to stay moist on the outside so in theory the water was cooler do to the evaperation. Any benefit of cooler water was more than negated by the aroma and flavor of the canvas bag. A treat I enjoyed again some years later when drinking water from a Lister Bag while doing a stint with the Army Infantry @ Ft. Knox.

Wow Ellen! you all had a 54' Studabaker? Was that the one which looked the same coming n' going? Truly an amazing car.

Glen

Wicket
Regular Member


Date Joined Aug 2006
Total Posts : 316
   Posted 9/27/2006 8:08 AM (GMT -7)   
Glen,
I don't remember it looking the same coming and going, but then I was only 11 and wasn't really into cars at the time.  Just as long as it had a back seat for me, my dolls and comic books was all I cared about.  Maybe it was a 55...not really sure.

Ellen
 
 
Curtis, 63,  Diagnosed Aug 21, 2006
T1C
Gleason 3+3=6, 3+4=7
PSA 4.10
 
Bone Scan Negative!!
DiVinci surgery scheduled for October 10th


KMiyoko
Regular Member


Date Joined Jul 2005
Total Posts : 73
   Posted 9/29/2006 10:51 PM (GMT -7)   

We have Kaiser Health Plan.  I went through their whole process of asking for them to pay for the Da Vinci prostatectomy at the City of Hope.  I was denied at  both of Kaiser's review levels.  I took it to the IMR (state level) request to have the Da Vinci Surgery and was denied by a Urologist who just did the open procedure.  He said that my husband did need surgery but could have the open or regular laproscopic surgery and that the Da Vinci was NOT necessary.  Since then we have talked to a number of men who have had the open or laproscopic surgeries, the recovery results are not a good as the Da Vinci surgery.  Even if it cost us a lot of money .....it was well worth it.  A year later and all of his test results are still what they call untraceable.  It is very hard to get HMO's to pay for this surgery, unless you hire a lawyer.

Kay


56pontiac
Regular Member


Date Joined Sep 2006
Total Posts : 230
   Posted 9/30/2006 5:52 AM (GMT -7)   
Thanks Kay. Did you have the DaVinci anyway? I spoke with the insurance company yesterday and was told they are going to do/pay something and that I would or should be pleased with their resolution. I will find out next week. Glad to hear your husbands results were good.

KMiyoko
Regular Member


Date Joined Jul 2005
Total Posts : 73
   Posted 9/30/2006 9:43 AM (GMT -7)   
Yes, my husband did have the Da Vinci surgery at the City of Hope. It was the best decision we made.  I'm glad your insurance company is willing to work with you.                                  Good Luck!
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