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PTNS denied after 6 treatments

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  • #1

    PTNS denied after 6 treatments

    My urologist of 20 years that also treats my IC talked me into to getting PTNS this past summer. His insurance clerk verified with my FED BC/BS that these treatments were covered and I proceeded excitingly. I had failed 4 different types of medications and botox to the pelvic floor. After my sixth treatment I receive an EOB from my insurance that they are not covering my PTNS treatments I called my urologist's insurance clerk and she assured me there must be some mistake because three of their other patients under the same plan had been covered and not to worry. If they didn't pay, there office would "write it off". She did appeal to my insurance who has apparently denied her appeal stating this procedure is "experimental" and they will not cover any of my expenses. I have received a big fat bill from my urologist and I am very stressed out. I am currently on disability and do not have the money to pay for this, I have been mislead, my IC is flaring, I will have to find a new urologist because I certainly will not go back to someone who has mislead me, etc. The worst part is the treatment was really helping, too. Now I'm back to square one with no relief in sight. Any suggestions would be greatly appreciated. Thanks, Beachbum
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  • #2
    Re: PTNS denied after 6 treatments

    It sounds like the only problem with your uro's office is communication. Please at least call the insurance clerk who told you it would be written off. It just sounds like an error that can be corrected. I would also ask that the physician appeal the decision with a request for an exception because the treatment is actually helping you. They may be able to get the coverage for you. If anybody misled you, I think I would blame the insurance company.

    Donna
    Stay safe


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    • #3
      Re: PTNS denied after 6 treatments

      I am sorry to hear about this decision especially when this procedure was beneficial. I am now trying to find out if Medicare will pay for my PTNS and I am being told it does. I have a secondary insurance company and they usually pay if medicare pays. I was told today by the business office that medicare does have a code for this procedure. I also found this article today while doing further research. It may be helpful. It is informative but may be information you already know.
      http://www.ncbi.nlm.nih.gov/pmc/arti...9/#!po=21.4286
      It is a document from a division of NIH talking about PTNS and SNS. The document does mention that PTNS is FDA cleared and even list the 2011 date. It does have a category I CPT code for medicare and medicaid services. Not to mention that the procedure is listed in the AUA guidelines. At this point there has been several studies done and is referenced by the NIH, AUA and accepted by medicare/medicaid (with a billing code). Just a few thoughts and I wish you good luck.
      Best Regards,
      Charles Wood

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      • #4
        Re: PTNS denied after 6 treatments

        So sorry to hear about the insurance issues. With all the money we pay them, you'd think that health and insurance came first. Go figure. I have been in your place a number of times. Even with the best insurance labor can buy!

        Fight it, fight it, fight it. Appeal with the help of your doc and if all else fails...since they cannot charge interest but you cannot ever clear your credit report without paying up or paying the minimum, just pay the very absolute minimum at a time. I think it is like 10 a month or something. At least they won't hurt your credit rating that way. Keep your head up and don't give up! Good luck!
        Love is a fruit in season at all times, within reach of every hand. ~ The Blessed Mother Teresa

        Status: Diagnosed October 2006 via cystoscopy with hydrodistention. Max anesthetized bladder capacity only 250 cc's. Mast cells and pinpoint bleeding found.

        Remission for me means less pain for more days than not. Frequency is inevitable with a bladder this tiny! That is ok though. The difference between when I was diagnosed and now, is that I have embraced that fact. Me and the loo, we are one.

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        • #5
          Re: PTNS denied after 6 treatments

          Thank you all for your compassion and advice. I have mailed my "Letter of Reconsideration" into my insurance company and pray they have mercy on me and approve it and pay for the PTNS treatments.

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          • #6
            Re: PTNS denied after 6 treatments

            You are in my prayers! Warmest regards and
            Love is a fruit in season at all times, within reach of every hand. ~ The Blessed Mother Teresa

            Status: Diagnosed October 2006 via cystoscopy with hydrodistention. Max anesthetized bladder capacity only 250 cc's. Mast cells and pinpoint bleeding found.

            Remission for me means less pain for more days than not. Frequency is inevitable with a bladder this tiny! That is ok though. The difference between when I was diagnosed and now, is that I have embraced that fact. Me and the loo, we are one.

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