Hey Hurtin Back. Unless things have drastically changed I think your doc is wrong. It would be odd for a doc to know what he will be comnpensated an what your portion would be for every insurance carrier.
I have medicare part A, B and now D. The major expense was the hospitilaization copay for a 23 hour stay. It was 790 2 years ago, I think it's 900 now. I had mine done at a catholic hospital and they reduced that by 2/3rds through their financial dept based on income.
As far as the pump itself, IT's not considerered durable goods with a huge copay. I would be sure the hospital you go to is coverd but that's all done pre op anyway. Aside from the hospital copay,I owed the hospital a couple hundred, I owed the surgeon a couple hundred and the anesthesiologist a couple hundred.
Medicare also pays for most of the meds if you have the right diagnostic codes for their use A refill costs me 55 bucks, an adjustment cost me about 30 bucks and a regular office visit about 20. Medicare has been great and was the only way I could have afforded to get off methadone as a primary pain med. After 3 years on it I was just sick of the way it made me feel or not feel, and I'm not talking pain wise.
Unfortunately medicare isn't great about being able to tell you what your portion is up front, and by the time they sort it out and they pay their portion it's been at least 60 days and everyone wants their portion once medicare pays.
Hopefully you had a succesful trial, that 900 copay to do an inpatient trial really sucked and it was a failure due to a spinal headache, but I did get good results from a single injection done at my clinic. I know every medicare carrier is a little different but that sounds outragous. My total cost was about 1100.00 before the hosiptal wrote off 500.
The initial adjustment period gets expensive with repeated office visits but it's a must as they usually start very low.
Thanks for the info on your pump implant. I don't know any other way to check out what Medicare would pay on the procedure. My doc said the $6,500 would be for the pump alone. I just don't see how that could be correct and that is the reason I am asking this question on the board.
Hey acks a hurtin, What I meant when I said it's not billed like durable medical goods, DB's are things like wheelchairs, cruthes, walkers portable omodes, etc. Something like that usually has a 50% copay, But the implanted devices is based on a predetermined price from the company that manages medcare for you. My company is CMS. But I had a choice of plan types when I first signed up for medicare a HMO, PPO or a pay for service plan where you just pay 20% of everyhing. Those plans are cheaper but 6K sounds in line for a 30K pump if you have that type of plan. You may be eligable for help from Medtronics. It can''t hurt to ask, the worst that can happen is they say no.
I have the older pump the synchromed 1 and, the synchromed 2 came out about 9/2004. Have you called your medicare managent co "the folks you get an explanation of benefits from" to see if they can give your more info. That comapany isn't the govt medicare, it's a private comapany that contracts with the govt to manage medicare. If you know you getting the synchromed 11, I would hope they can help, but if you need a billing codeyou probably need tha from your docs office.
I would talk to his billing dept. He may be spouting some marketing stuff that the medtronics rep said he would make X amount on every implant. My pump cost 30K too but was negotiated considerably down by the ins co. In general I haven't met a doc that knows what the meds cost they prescribe, unless you tell them.LOL
A big part of my decision was oral med cost, Anything other than meth and I was looking at at least 700 a month for the bare basics. I couldn't afford anything but meth and it made me feel wrotten. Things worked out well in my case, but I was given a break on the copay because I asked. If you don't ask, they won't offer.
Unless medicare wants the docs to use the synch 1 instead of the synchromed 11 because of some astronomical cost difference, the synchchromed 1 has been around since the 80's and well proven and wouldn't make a difference to me if that's the problem. The big advantage of the new pump is just a larger resevoir, which means you can go longer between refills, but the DEA wants a closer eye kept on us anyway. So I have pump visits and visits to satisfy the dea and pick up scripts for oral meds.
Even with all the titrating and med changes and trials it is still very cost effecient. Plus it makes dilaudid an optinon and baclofen is far more effective IT than orally if you can tolerate the side effects. They can use sufentanyl, morphine or prialt. I haven't heard much about prialts use from posters but it is an option.
Good luck with your research. Personally I'm glad I did it, but it's really just a tool. Some people have amazing cured me stories, but for me it just a better way to deliver medication.
Take care, Dave
My first pump that I had put in 1997 and I know the pump alone ran 12,000 dollars. I was amazed and that was not the hospital cost. The second I did not stay overnight so I am not quite sure how much that one cost ( it was two days after 9/11 and people had other things on their minds. I am having the third put in this fall and with the larger port I know I will not have to go in for refills that often like now. The refills are 1,200.00 each time for morphine, room use etc.. I have disability insurance thru the state of Ohio and my husband has a private insurance where he works. If I remember right I didn't have to pay much if any. Take care and stay save geifer
My doc has recommended that I have a pain pump. I am on SSD with only Medicare as insurance. He told me that my copay would be around $6,500.
How have all of you paid for the implant? I am wondering if there is any kind of supplemental insurance to be had by the disabled? I am in Texas.
Thanks in advance.
I joined Humana Gold this year. Wish I had done it my first year of disability. I pay $60 per month for prescription drug coverage, $8 generic and $80 non generic. The pump was priced at $6500 w/out Humana and cost $650 with Humana...I also have Dental, Stop Smoking Patch $0 cost, Eyeglasses, Wellness Prostate tests and on and on.