Insurance Coverage For Hifu

I found a link on the DailyStrength forum that a few patients received coverage thru Blue Cross/Shield insurance.

This could change the way most patients handle their prostrate cancer treatments.

HIFU appears to be more viable now as a valid treatment.

Insurance companies are probably starting to see less complications from this type of treatment and thus taking the risk that this treatment is worth paying for upfront vs the long term effects the other treatments have caused. (Insurance companies look at good/bad stats to make their coverage decisions)

Some hope for the rest of us getting this approved by FDA.

Randy 

On 7/25/2008 LYNBREN wrote:

Which Blue Cross is covering HIFU?

Not sure on the exact group/coverage.

The person reporting  didn't state the specific plan.

Best to call your insurance first and check with them. 

Here is the link:  http://dailystrength.org/c/Prostate_Cancer/forum/3289781-pos

Appears they paid up front submitted paperwork and received 85% reimbursement of fees. 

RS

On 7/25/2008 rsfly wrote:

 

On 7/25/2008 LYNBREN wrote:

Which Blue Cross is covering HIFU?

Not sure on the exact group/coverage.

The person reporting  didn't state the specific plan.

Best to call your insurance first and check with them. 

Here is the link:  http://dailystrength.org/c/Prostate_Cancer/forum/3289781-pos

Appears they paid up front submitted paperwork and received 85% reimbursement of fees. 

RS

Interesting.

I wonder what this person would gain by lying?

I've had different results from Blue Cross when I have called.

example: 

1.  I had my biopsy done in NV (I live in CA) 4 miles from boarder.

2. When we called about billing BC said this Dr. was out of  my network and that I would have to pay another $750 dedictable plus a 30% out of pocket vs only a 10% with no Deductible.

We called the urologist and spoke with the finance dept which stated that they indeed were in my Network from the group and Id I had given them

My wife called the Blue Cross  800 number  again and told them what we were told. They again said this doctor was not in network. By then I was very concerned since I was about to get a $1500 bill vs $150.

Finally the bill came, we DID NOT have to pay the deductable, only 10% vs the 30%.

So go figure. I don't think these organizations that answer the phones are very organized. They really don't have a clue on what's covered.

It all depends on who you talk to at the time.

RS 

On 7/25/2008 rsfly wrote:

Interesting.

I wonder what this person would gain by lying?

I've had different results from Blue Cross when I have called.

example: 

1.  I had my biopsy done in NV (I live in CA) 4 miles from boarder.

2. When we called about billing BC said this Dr. was out of  my network and that I would have to pay another $750 dedictable plus a 30% out of pocket vs only a 10% with no Deductible.

We called the urologist and spoke with the finance dept which stated that they indeed were in my Network from the group and Id I had given them

My wife called the Blue Cross  800 number  again and told them what we were told. They again said this doctor was not in network. By then I was very concerned since I was about to get a $1500 bill vs $150.

Finally the bill came, we DID NOT have to pay the deductable, only 10% vs the 30%.

So go figure. I don't think these organizations that answer the phones are very organized. They really don't have a clue on what's covered.

It all depends on who you talk to at the time.

RS 

On 7/23/2008 rsfly wrote:

I found a link on the DailyStrength forum that a few patients received coverage thru Blue Cross/Shield insurance.

This could change the way most patients handle their prostrate cancer treatments.

HIFU appears to be more viable now as a valid treatment.

Insurance companies are probably starting to see less complications from this type of treatment and thus taking the risk that this treatment is worth paying for upfront vs the long term effects the other treatments have caused. (Insurance companies look at good/bad stats to make their coverage decisions)

Some hope for the rest of us getting this approved by FDA.

Randy 

Randy:

I am a Urologist who is very involved with HIFU.  Many of my Blue Cross patients have , in fact been reimbursed for their HIFU procedure that was performed in Mexico or Nassau. Blue Cross will NOT authorize payment upfront, prior to the procedure as HIFU is not FDA approved in the USA. However, many of my patients have been sucessful in downloading an international claims form from the BC website and filing it AFTER the procedure with the requested documentation. There is no guarantee that the claim will be paid, but I would estimate taht about 60% of my patients have been successful in this regard.

Good Luck

UroDoc

Hi Uro Doc,

Just needing you opinion on something. My husband was diagnosed with T-1 low grade, low volume cancer in June 2008. His Gleason is 3+3=6 and his psa was 4 with a volume of 33. He is only 50 years old, and after the biopsy was confirmed at John Hopkins, so our search for treatment began. His Uro does the HIFU in both Mexico and the Bahamas for 25K. ALthough we don't have the money we could get a loan for this procedure. We have several reservations we are concerned with. Firstly, Have you personally ever perfomed the HIFU on a man as young as my husband. We have spoken with both Duke and Vandy regarding their clinical trials and they both say my husband is just too young for the HIFU, because of the chance of re-occurance. Secondly, I have heard that some of the european countries are reporting that some of the patients they performed HIFU on are having reoccuring cancer 7-10 years post op. Our goal is complete erratication of the cancer with minimal effects such as the incontinence and E.D. issues. Our decision is about 50/50 on both the HIFU as well as the Radical retro pubic prostatectomy. We like the radical for the % of non-reoccurance once the prostate is completly removed. Any advice that you could share regarding your patients age and your reasoning for chosing one treatment over another would be greatly appreciated.  

Regards,

Michelle