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Medical Forum / Diseases and Disorders / Prostate BPH / December 2003PVP or TURP?
Saw my Urologist today, he suggests surgery is needed.... he also pointed out the TURP is the only procedure my insurance will cover. So..... it looks like I'm going to have to pay for anything other than a TURP and this means I'm shopping. Is there anyone in Arizona that's had a TUNA or PVP or whatever procedure and if so, what was the cost? I'll probably be calling around early next year but any information I can get now would be helpful. I think your doctor is mistaken about insurance only covering TURP. Blue Cross/Shield covered my PVP. I think the doctors must know the correct "code" when submitting the paper work to the insurance company. I saw the words "TURP" on one my insurance statements but I know I was given a PVP. Talk to doctors who do PVP, if that is the procedure you want, and let them work out how to interface with the insurance company. I would not bother contacting your insurance company and asking if they cover PVP. They do not know what PVP is. Let the doctor handle that end. Because a PVP results in a shorter hospital stay, it ends up being cheaper for the insurance company and you. Dave > Saw my Urologist today, he suggests surgery is needed.... he also > pointed out the TURP is the only procedure my insurance will cover. [quoted text clipped - 7 lines] > I'll probably be calling around early next year but any information I > can get now would be helpful. > I think your doctor is mistaken about insurance only covering > TURP. Nope, they only cover TURP. PVP is covered by insurance. > Saw my Urologist today, he suggests surgery is needed.... he also > pointed out the TURP is the only procedure my insurance will cover. [quoted text clipped - 7 lines] > I'll probably be calling around early next year but any information I > can get now would be helpful. > PVP is covered by insurance. Mine specifically covers TURP and ONLY TURP. I doubt it. Crosscheck your insurance plan with the Laserscope doctors. If you find a Laserscope PVP doctor in your plan, then your insurance has to cover PVP Patrick > > PVP is covered by insurance. > > Mine specifically covers TURP and ONLY TURP. > I doubt it. Crosscheck your insurance plan with the Laserscope > doctors. If you find a Laserscope PVP doctor in your plan, then > your insurance has to cover PVP There isn't. Trust me on this one, they specifically do NOT cover PVP, already checked. I've already told the Uro I wasn't going to have anything now, maybe in another year things will change. PVP might be covered by insurance. Not all carriers provide coverage for that procedure. You will need to check with them. My carrier initially denied coverage. I appealed their decision and finally won. Most insurance contract language gives them the right to determine what they cover and what they don't. Some will, some won't, and some may if prodded enough. Inquire about their process for determining coverages and about their appeal processs. Then be prepared to fight. You can win. Dennis Dennis > Saw my Urologist today, he suggests surgery is needed.... he also > pointed out the TURP is the only procedure my insurance will cover. [quoted text clipped - 7 lines] > I'll probably be calling around early next year but any information I > can get now would be helpful. > PVP might be covered by insurance. Not all carriers provide > coverage for that procedure. You will need to check with them. My [quoted text clipped - 4 lines] > their process for determining coverages and about their appeal > processs. Then be prepared to fight. You can win. There's no discussion or appeal, I get TURP or pay for it myself. >There's no discussion or appeal, I get TURP or pay for it myself. I don't know what deductible or co-insurance percentage you have to pay under your insurance, but it might be beneficial for you to do a little math. You might find its cheaper to pay for the PVP than to pay your portion of TURP. PVP can often be done in the doctors office for about $2,500. If you have the PVP in the hospital there will be another $15,000 or so just for the operating room, not to mention the hospital stay, etc. I doubt the hospital costs would be any less for TURP. So if you share is going to be 20%, for example, it would be cheaper to pay for the PVP in the doctors office by your self. Personally I'm expecting to get PVP early next year. I think I'd take a second job to earn the $2,500 to have a PVP instead of the TURP. But, that's just me. > >> >>There's no discussion or appeal, I get TURP or pay for it >>myself. Seems to me your insurance company might think again if it thought prospective clients would go elsewhere when they learn they only support outdated technologies. I'd write to the president of the company suggesting that it might be time they updated their ideas. If they don't want to do that, it would certainly make an interesting story for the newspapers. Derry >> >>> [quoted text clipped - 8 lines] > that, it would certainly make an interesting story for the > newspapers. I really doubt if that would help. TURP is still the "gold standard" according to the majority of Urologists and they'd simply claim they were following established procedure. My Uro was familiar with the various different procedures, but none has been accepted yet. Maybe some time in the future....? The group is pretty progressive, one way they control costs is to maintain their own infrastructure, they have their own pharmacy so they can control drug costs, their own labs for testing, their own X-ray, CAT scan and MRI equipment, their own specialists for vision, hearing, cancer, obstetrics, neurology, podiatry, etc. etc. plus their own surgical center (my friend had her cataract surgery done there) and urgent care center. Possibly one or more of the newer BPH treatments will be added but there's no predicting when. > I don't know what deductible or co-insurance percentage you have > to pay under your insurance, but it might be beneficial for you to > do a little math. You might find its cheaper to pay for the PVP > than to pay your portion of TURP. There's $150/day for the hospital (up to 6 days, no co-pay after 6 days), $35 for the doctor. > PVP can often be done in the doctors office for about $2,500. If > you have the PVP in the hospital there will be another $15,000 or > so just for the operating room, not to mention the hospital stay, > etc. I doubt the hospital costs would be any less for TURP. If I had the PVP, I'd pay the $2,500 plus probably the $15,000 as there would be NO coverage if I went out of network. The obvious choice is to do neither for now. I appreciate the input, the price was what I needed. I will call some local doctors and check their prices but at least I've a reference. >If I had the PVP, I'd pay the $2,500 plus probably the $15,000 as there >would be NO coverage if I went out of network. Sorry I didn't make it clear enough. If your Uro can do the PVP procedure in his office, and if there is no medical reason why you shouldn't have it done in the office instead of the hospital, there will be no $15,000 charge. The total bill in the office should be around $2,500. The TURP must be done in the hospital therefore the price will be $15,000+. Your share in this case could be more then the $2,500 for the PVP. >The obvious choice is to do neither for now. Watchful waiting is an alternative if possible. >I appreciate the input, the price was what I needed. I will call some >local doctors and check their prices but at least I've a reference. The reason I'm familiar with these numbers and situation is when I first approached a Uro in my area who does PVP his office said they did not accept my particular insurance plan. Another Uro would accept the insurance plan, but did not have the PVP equipment in-house and would require it to be done in the hospital. After comparing the office/hospital costs I decided it was going to be a lot cheaper to pay the full amount and have the office procedure done. Luckily, after talking to the insurance company and making the Dr.'s office recheck with the insurance company everybody decided that they would accept my insurance plan. >>If I had the PVP, I'd pay the $2,500 plus probably the $15,000 as >>there would be NO coverage if I went out of network. [quoted text clipped - 8 lines] > $15,000+. Your share in this case could be more then the $2,500 > for the PVP. The TURP will cost $150 co-pay for the hospital and $35 for the doctor. The total bill would be around $185. Or, since I don't particularly want to have the TURP, it will cost nothing to not do it.. ;-) We'll see what next year brings. Tell us your insurance company. I am certain that we can find a doctor who takes your insurance and does PVP. Patrick > > I don't know what deductible or co-insurance percentage you have > > to pay under your insurance, but it might be beneficial for you to [quoted text clipped - 16 lines] > I appreciate the input, the price was what I needed. I will call some > local doctors and check their prices but at least I've a reference. > Tell us your insurance company. I am certain that we can find a > doctor who takes your insurance and does PVP. CIGNA Senior Care. Good luck! I have Cigna. It paid 100% of Dr. Te's bill, New York Hopitals bill and the anestheslogist. Cigna covers PVP, no doubt about it. Patrick > > Tell us your insurance company. I am certain that we can find a > > doctor who takes your insurance and does PVP. > > CIGNA Senior Care. Good luck! > I have Cigna. It paid 100% of Dr. Te's bill, New York Hopitals > bill and the anestheslogist. Cigna covers PVP, no doubt about it. > Patrick It's not CIGNA, it's CIGNA Senior Care. Completely different... I can't go out of network w/o a referral and the Urologist won't give it (if he did, they would cover it). Same thing on drugs, there's dozens of pharmacies that take CIGNA but I'm not allowed to use them, no matter what. I'm pretty sure they wouldn't cover the back surgery I had at this time, I had it done before I hit 65 so I wasn't on the senior care program. I contend that there is an "in network" laserscope urologist somewhere near you. I don't know where you are located but, Dr. Te is "in-network" for Cigna Senior Care. All you need to do is to get your primary doctor to give you a referral to an "in network" urologist that does laserscope. If you really want a PVP instead of a TURP, you are giving up too easily. The guys over in the UK have to fight and wait for their PVPs. Here in the US, at the end of 2003, men with BPH have over 400 doctors to chose from for PVP. Plus it is approved by Meidcare and every insurance company. Note that based on our discussion, you have went from "my insurance doesn't cover PVP", to "the particular in-network urologist that my primary care physician refered me to does not do PVP. That's a big difference. With a little more effort you can line up the PVP. However, if you want to take the risks associated with having a TURP after you are now very knowledgeable about the differences, so be it. In any case I wish you well and a speedy recovery. Patrick > > I have Cigna. It paid 100% of Dr. Te's bill, New York Hopitals > > bill and the anestheslogist. Cigna covers PVP, no doubt about it. [quoted text clipped - 9 lines] > wouldn't cover the back surgery I had at this time, I had it done > before I hit 65 so I wasn't on the senior care program. Yes, something is fishy here!!! Mel > I contend that there is an "in network" laserscope urologist somewhere near > you. I don't know where you are located but, Dr. Te is "in-network" for [quoted text clipped - 30 lines] > > wouldn't cover the back surgery I had at this time, I had it done > > before I hit 65 so I wasn't on the senior care program. > I contend that there is an "in network" laserscope urologist > somewhere near you. Yes, there are two. Neither is available for the Senior Care program as far as I can find out. > All you need to do is to get your primary doctor to give you a > referral to an "in network" urologist that does laserscope. Since they have their own Urology department, they won't refer outside of it, I've already been down that road. > Note that based on our discussion, you have went from "my > insurance doesn't cover PVP", to "the particular in-network > urologist that my primary care physician refered me to does not do > PVP. That's a big difference. Which sums up to "my insurance doesn't cover PVP". Does the "Since they have their own Urology department, they won't refer outside of it..."" mean they do the TURP themselves? Or do they refer to a doctor outside the insurance company? If the insurance urology folks do it themselves, then ask the insurance company president/CEO if (s)he condons paying twice as much for a procedure that has higher morbidity, lower patient satisfaction, but with equal clinical endpoints. Ask the question even if they refer outside. Someone outside the Medical Director staff needs to understand the decision they are making. Dennis > > I contend that there is an "in network" laserscope urologist > > somewhere near you. [quoted text clipped - 14 lines] > > Which sums up to "my insurance doesn't cover PVP". > Does the "Since they have their own Urology department, they won't > refer outside of it..."" mean they do the TURP themselves? Yes. > > I contend that there is an "in network" laserscope urologist > > somewhere near you. > > Yes, there are two. Neither is available for the Senior Care program > as far as I can find out. Did you call these two the laserscope doctors up and ask them if they take your insurance. They will do the necessary checking for you. If they take it (i.e. are Cigna member doctors, get their referal number and take that number to your primary and get him to refer you to that doctor. With Cigna, the primary care can not stop you from getting referred to another Cigna network doctor. What state you you live in? Is Dr. Te in NY to far for you? > > All you need to do is to get your primary doctor to give you a > > referral to an "in network" urologist that does laserscope. [quoted text clipped - 8 lines] > > Which sums up to "my insurance doesn't cover PVP". I had a TUNA performed in Nogales, Arizona 4 years ago. It was successful to a point but now it's time that I have it done again. This time I want a PVP performed. Hope that I can find a physician in the Tucson area to do the job for me. My insurance did cover the cost of the TUNA. If you have any questions, write me at apfvrf@hotmail.com Al |
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