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Old 07-18-2007, 11:07 AM   #1
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Question Pain Pump Co-Pay w/ Medicare?

I am being referred to a pain mamagement doctor here in Las Vegas, NV and it is for a Consult for the implanted pain pump.

I know that I have to have a "Trial" and the "Permenant" placement of the pump if all goes well. Does anyone have any idea how much this will cost me for everything invovled...Trail, Outpatient facility, ALL Doctor charges, Permenant Surgery to place the pump, Hospital stay, any other costs?

Thanks in advance for your help!

Tony111

 
Old 07-27-2007, 11:59 AM   #2
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Re: Pain Pump Co-Pay w/ Medicare?

Has anyone with just Medicare for insurance know what the copay will be when getting a "Pain Pump"?

Inclucding the Trial and Permanent implant!

Thanks,

Tony
__________________
C4,C5,C7,T1 Spinal Stenosis
C5&C7 Radiculopathies
C5-6,C6-7 Surgical Fusions-1991
C7 - Psuedarthosis(collapse of bone graft and chronic nonunion)
T1,T2,T3-Herniations
L4-5&5-S1 - Surgical Fusions with Instrumentations-2001
Spinal DDD
Chronic Headaches
Fibromyalgia
Chronic Pain Syndrome
Chronic Fatigue Syndrome

 
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Old 07-28-2007, 11:06 AM   #3
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Re: Pain Pump Co-Pay w/ Medicare?

Hi Tony and TonySac: I don't have a pain pump, but I do have Medicare and looked into it several years ago. Can you call Medicare and ask what they pay, or the dr to see if any other patients have this type of coverage.

Do either of you have Medicare Part D rx coverage? You can usually find out how much the med will cost through your Part D insurance co.

If you only have Medicare, I "don't" think they will pay for the refills. I think you have to have some type of rx insurance to pay for that part of it. The cost through Part D would depend on which med they are using and if that particular med is covered on the insurances formulary.

Medicare should be able to tell you something about the cost of the procedure and if they cover any of it.

Good luck...

Last edited by DesertBloom; 07-28-2007 at 11:07 AM.

 
Old 07-28-2007, 12:43 PM   #4
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Re: Pain Pump Co-Pay w/ Medicare?

Hey Tonys', Medicare does cover the pump refills under medicare part B as supplies used for the office visit, The prescription plan has nothing to do with pump meds. They are ordered by the doc and shipped to his ofice. It costs me about 35 bucks to have my pump refilled every 70 days and about 20 bucks for the apts where they simply make adjustments to the pump settings.

When I had my pump implanted in 2003 it cost me about 1200 and the biggest part was simply the $750 hospital copay with Medicare part A "hospitilization". Every time your admitted you pay this copay

The number of days you stay makes a small difference and you can do out patient trials to avoid the copay depending on how your doc prefers to do the trial. My in inpatient trial was a failure due to a spinal fluid leak but I had great success with a couple single bolus injections done at the office and went ahead with the implant 6 months after the failed in patient trial.

Your doc may or may not do the recomended psych eval and testing which is another expense that cost me about $250. I was surprised by how well medicare covers management and refills of the pump under part B "office visits". Medicare is like any other HMO where a doc excepts a set fee and writes off the rest.

Good luck, Dave

 
Old 07-28-2007, 02:05 PM   #5
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Re: Pain Pump Co-Pay w/ Medicare?

Hi Shoreline: Thanks for the info, I've always wondered about this, and since I don't have it wasn't sure if it was covered or not.

 
Old 07-28-2007, 07:57 PM   #6
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Re: Pain Pump Co-Pay w/ Medicare?

No problem desertBloom, I guess I should have added. despite it taking 6 months and 16 adjustments, it was the best thing I ever could have done. For me I knew it was a life decision, so taking 6 months to find the right dose, med and schedule was well worth it. The end result is the abilty to focus on something other than pain and when it's time to take more pills.

It's really the last resort when living on meds and the side efects are robbing you of a life as much as the injury and pain itself. I still have times that are miserable, but I choose to live for the times that aren't. It's what you choose to do with the relief you get that really matters, although for medicare patients, when orals are too expensive, the pump is a cheaper way to deliver meds you might not be able to afford, Before part D "18 months ago", the only affordable choice was methadone and that was part of my decsion to have the pump implanted 4 years ago. I knew I did better on other meds but couldn't afford them.

The actual bill for the refill vists are like 900 bucks, but once they negotiate the price, my portion is cheaper than my wifes copays on name brand meds. The new synchromed 11 will alow me to go twice as long betwen refills with a resevoir in the new pumps twice the size of my 18ml.

It was the right decsion for me, but it's certainly not for everyone.
Good luck, Dave

 
Old 07-30-2007, 03:14 PM   #7
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Re: Pain Pump Co-Pay w/ Medicare?

Thanks Shoreline! I have been trying to find out the costs for the last six months.

I'm on 2 100 mcg fentanyl patches every 2 days and Roxicodone 30 mgs q4h for BT pain. My pain doc left last year and I had a lot of trouble finding a PM Doc to take over my meds. Found one just out of school and she won't go any higher,nor do I, and only does SCS's...which she tried to push me into getting. She does NOT do the pumps! All the research and people that have them say that the SCS is not that great and is mostly for nueropathic pain. Most all my pain is ALL of my spine, or back, head and sacrum.

My current doc does NOT do pumps...says there are too many granulomas and other life threatening things that can happen with the pump, like having the catheter come out and withdrawals or when filling the pump if they miss the diaphram and inject into the body I could die, etc, etc.

After being vertical for 30-60 minutes I'm in so much pain that it won't go away till I get some sleep at night. The BT pills don't touch the pain. My pain doc gives me 6/day and said I can take up to 3 at a time but no more than 6/day. I save 3 pills for evening as one or two pills don't even touch the pain. That means that once I try and do some household items or go out for an errand or two I have to get off my feet for the rest of the day and the pain continues to be pretty bad. It won't go away but if I don't lie down it just keeps getting worse till I'm at an 8-9. I just can not get anything done and am getting weaker lying around in my recliner or in bed. The costs for my meds are too much and I am not getting the relief I used to get with the patch. We started at 100 mcgs and have upped it twice in the last year with not much improvement. Helps for a few weeks and then the pain is back.

Also, there is only one insurance in Part D that covers the 30 patches/month which costs me close to $1,200/mo during the Gap. Last year I had to pay the whole gap($3,600) in a couple of months. If this insurance I have now changes their formulary or Tiers next year I'll be paying out $4,000 during the gap each year which I can not afford. It's a good possiblity that they will change it sometime and I won't be able to afford it. I'm already not taking some of my other meds due to costs. Right now my art d insurance covers all generics at $6 co-pay so I'm getting by this year!

I tried all the other meds and the fentanyl (Sandoz) was the only thing that worked for several years. But I am getting worse and now it does not work like it used to.

Like you I have had several failed two level fusions..one cervical and one level collapsed and never fused. Plus, it was back in 1991 and I just had a new MRI and have herniations and stenosis at just about every level in my neck and all the thoracic levels that can be seen down to T4. Bone spurs are causing central and foraminal stenosis. Then in 2001 I had a 360 Lumbar two level fusion(L4-S1) with hardware and it was put in crooked...tilts to the right. That causes a curve in my spine like scoliosis so my whole back hurts from head to sacrum where they put the screws in. Plus all the other lumbar discs have herniated since then.

I spoke with someone who saw a P.M. doc here in town that she had seen and had the pump put in and says he is great. He has stopped taking patients that other docs have put the pump in, nor will he take patients that just want there scripts. He has a Ffellowship in Anesthesiology and Pain Management so he is extremely busy. But, he will see new pain pump patients for a consult. I now need to get my current pain doc to refer me to him. Don't know how my current pain doc will feel about that, but I needed to know the costs of the procedures and refill costs before I even asked her to do that.

From what you told me I guess with today's hospital co-pay with Medicare it
will cost me around two thousand or more to have the trial and the permenant placed if it works. Still better than paying the Gap every year!

Do you have concerns about the granulomas? They do not know what is causing them. I have talked to people in the Pumpsters group and since they discovered the granulomas, the doc's are checking more of their patients and there are people that have the growth when under 20 mgs and under a year. They think it may be inflammation from the meds.

One last question! When the pump wears out will Medicare pay for the replacements?

Thanks Again Shoreline. I'm so happy that you are doing so well. I know you were at a lose of what to do for quite some time. Glad this has worked for you. You deserve it!

Tony
__________________
C4,C5,C7,T1 Spinal Stenosis
C5&C7 Radiculopathies
C5-6,C6-7 Surgical Fusions-1991
C7 - Psuedarthosis(collapse of bone graft and chronic nonunion)
T1,T2,T3-Herniations
L4-5&5-S1 - Surgical Fusions with Instrumentations-2001
Spinal DDD
Chronic Headaches
Fibromyalgia
Chronic Pain Syndrome
Chronic Fatigue Syndrome

 
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