Medicare stepped up for Sculptra and Radiesse...

[klipsch]

I know absolutely nothing about the details of this action. But I was told by my doctors secretary that the problems they were having with getting paid, have been resolved.
I had called to ask why the doctor had used Radiesse on my last visit, because I thought that we had used all that I had purchased already? She went to pull my file, and replied "Oh...you're on Medicare now"...and explained that they were being paid as they should now.

[TnMan62]

So, am I understanding that Medicare is covering Sculptra injections these days?

[klipsch]

So, am I understanding that Medicare is covering Sculptra injections these days?

Yes

[burstnbloom]

klipsch
do you mind if i ask what state you are from ? I live in Georgia and have had no luck finding any provider that will fool with medicare and the radiesse/sculptra injections. thanks

[jm1953]

Last time I had Sculptra last year they said Medicare only would cover $100.00 of it.  The procedure and meds cost about $1,600 total in my case, but I am on the patient assistant program which pays for the meds $1,100 for two viles I think.

Has something changed?

[Oceanbeach]

I had 1 of 6 Sculptra sessions last Spring.  It was billed to Medicare at $6480.00 for Pharmacy and $448.00 for Clinic.  Payment was declined on May 13, 2011, declined again on July 4, 2011.  Last week the statement was sent again.  Gotta admire the tenacity of the UCSF Billing Department.  Meanwhile in an HIV Benefit, there was a make up clinic where they taught me how to use make up to cover the lipodystrophy.     Have the best day
Michael

[denb45]

I had 1 of 6 Sculptra sessions last Spring.  It was billed to Medicare at $6480.00 for Pharmacy and $448.00 for Clinic.  Payment was declined on May 13, 2011, declined again on July 4, 2011.  Last week the statement was sent again.  Gotta admire the tenacity of the UCSF Billing Department.  Meanwhile in an HIV Benefit, there was a make up clinic where they taught me how to use make up to cover the lipodystrophy.     Have the best day
Michael

SAY WUT........Well strap me to a gurney pump full of drugs and wake when it's over, I know dam well medicare will pay for this, I've done it before
and I'm not speaking of Sculptra and Radiesse.....LOL   

[Oceanbeach]

SAY WUT........Well strap me to a gurney pump full of drugs and wake when it's over, I know dam well medicare will pay for this, I've done it before
and I'm not speaking of Sculptra and Radiesse.....LOL   

Oh Yeah, it is actually simple... You take a bit of bright clown paint to cover the dark patches and put some foundation on over it and save about $7000 in Medicare bills that never get paid     Have the best day
Michael

[Miss Philicia]

Why haven't you tried the patient access program -- the filler is free is you make under 40K

http://www.refreshmylook.com/sculptra-patient-access-program-san-francisco

This is what I do, though I pay a doctor's fee to do the injections, but it's just $50/session so as you can see that's very discounted from the $448 that your doctor is billing. But Medicare is only, at best, going to cover 80% of that $7000 anyway so...

[denb45]

I don't need any facial fillers, I know I look good, lipo and all 

[Oceanbeach]

Oddly enough... I was just reading that 50% of all Americans have pre-existing medical conditions that may prevent them from buying insurance.

100% of the 249 congressmen voting to repeal health care have their health care plan paid for by those Americans     Have the best day
Michael

[Oceanbeach]

Why haven't you tried the patient access program -- the filler is free is you make under 40K

http://www.refreshmylook.com/sculptra-patient-access-program-san-francisco

This is what I do, though I pay a doctor's fee to do the injections, but it's just $50/session so as you can see that's very discounted from the $448 that your doctor is billing. But Medicare is only, at best, going to cover 80% of that $7000 anyway so...

I like Phylatio...  The office location is around the corner from my Temple of Worship (Macy's) but, Dr. Mossers fee for injection is $500, regardless of how many vials are used.  UCSF charged my Medicare account $448 for the first of 6 injection appointments.  The bottom line on their statement reads, "Total $6928.00, Pay This Amount $0.00.  UCSF has a full time Insurance Coordinator, who should have known Medicare was refusing payment on Sculptura treatments.  I am one of 7 people living with HIV/AIDS, approved then dropped by this Insurance Coordinator.

David, thank you for the link but Dr. Mosser's fee would be $3000 for injections and I can't afford that.  Before giving up, I did call his office to confirm the costs of his services.  Product is free, injection is $500 per appointment and completely out of my price range.       Have the best day
Michael

 

[Miss Philicia]

I find it hard to imagine that, being a bit more resourceful than going off my link (as a person who doesn't live there), that there isn't a doctor doing what mine is -- meaning greatly reducing their rate for people who qualify for the access program. He does not charge that for a non-access patient. This is at a LGBT-centered medical clinic downtown. Have you tried locating a LTS support group where someone might know of a resource?

I'm still curious though, did UCSF tell you they would accept payment "on assignment" and not charge you the 20% that Medicare doesn't pay? Or will you have to pay ~$1400?

[Oceanbeach]

UCSF has always charged Medicare Parts A & B and Medi-Cal.  I have never been charged for a copay and receive statements following each medical visit with dates, times charges and insurance company name.  At the bottom it always says "pay this amount $0.00."  My charges in 2011 were nearly $40,000, with no share of cost. 

Some of the 7 UCSF clients signed waivers making them responsible for payment.  I refused to sign the waiver because if Medicare did not pay, I could not afford any part of the procedure.  I was accepted, first appointment scheduled and after the first session, I was asked to meet with the Insurance Coordinator.  He asked that I wait until Medicare paid for this session before scheduling my next visit.  I am not responsible for any part of the payment.

Union Square office space is worth a fortune.  They have (2) 6 story Macy's stores with Basement levels, Needless Mark Up, Victorius Secret... it has the Cable Cars and the open air tour buses, a shoppers paradise.  I called the Union Square Plastic Surgeon listed on the link knowing there are thousands of Board Certified Plastic Surgeons in San Francisco.

Being a gay man, I have to SHOP!  I will print out the Access program application, some copies of my SSDI Award Letter, my Medicare and Medi-Cal cards and visit some other clinics in person.  Thanks again for your help     Have the best day
Michael   

[Miss Philicia]

Hope it works out for you. I think I had an initial 3 or 4 injection sessions, and then one touch up 15 months later. I've had it put in my temples as well as my cheeks.

[denb45]

Question? does your current ID-Doc have to refer you to a specialist to get this done?

I ask my ID Doc about this a yr. and a half ago, and she told me

 ( laughing, Dennis, you don't need this) "you don't have lipo in your face, nor do you have any body-wasting at all that I can see, if I thought you needed this I would have gotten you this"

 however I didn't ask her if she could do this procedure...

I also had a previous Doc before her tell me exactly the very same thing.....

[Miss Philicia]

Every doctor I've had since ~2000 has ID'd my having lipoatrophy, in my face, arms and legs. In fact my current doctor exhibits me to his students when they're assisting him (he teaches a class at U-Penn, and of course he asked me if this was OK).

Dennis, I've seen pictures of you and though I'm not a doctor I'd have to say I disagree. But you're also +50 and I was 35 when the first doctor told me I had it, so it was clearer in my case to separate aging issues. I would assume your current doctor is aware that you were once on Zerit and for how long?

Other than that you don't "technically" need a referral if you're on Medicare, that goes for any doctor. However, my doctor did advise me on who he thought I should have do it, and I was comfortable with the recommendation as a friend of mine had already been going to him for a few years.

[denb45]

Wow, I had no idea that you have suffered from lipoatrophy for such a long time 

I suppose I could ask you this, and I'm so sorry that you had to go thur this alone 

here's a big fat naked HUG for you, I'd give you one in person, if I could, maybe I'll get to that someday 

and I'd like to apologize to you if I've ever said anything that may have hurt your feelings 

I never really gave much thought as to how I look to others, I'm just happy to be alive, and try not to dwell on any negativeness, however thanks for you honesty 


with much love & all the needed support

Dennis 

[klipsch]

Why haven't you tried the patient access program -- the filler is free is you make under 40K

http://www.refreshmylook.com/sculptra-patient-access-program-san-francisco

This is what I do, though I pay a doctor's fee to do the injections, but it's just $50/session so as you can see that's very discounted from the $448 that your doctor is billing. But Medicare is only, at best, going to cover 80% of that $7000 anyway so...

The patient assistance program used to be good. But a few years ago they changed their policy. Dermik now limits you to 2 kits (4 vials?) every two years. Depending on the the severity of facial wasting that somebody has experienced...2 kits isn't going to get you far, even just for maintenance.

[Miss Philicia]

1) Sculptra is now owned by Sanofi, not Dermik -- happened sometime last year.

2) when I was last at my doctor and reapplied for the patient assistance program with Sanofi I was told the only difference is that they don't send all of the 2 year's worth of vials at once, but send them only 2 kits at a time. Is that what you mean? I believe that you still get 6 kits, 2 vials per/kit, or 12 vials.

3) the link I provide below also has a program application form, and it's with Sanofi, so I assume that this is the current information

4) what you stated regarding the amount of vials several years ago is not what I had from Dermik, irregardless of current program described above

[klipsch]

Didn't know about the change of hands...but was told last week that the patient assistance program was limiting to 2 kits for the 2 year application period. I ran into this I'm going to say somewhere in the 2009 - 2011 time period, since I started this thread Sept 2011. Now that was based on my initially applying for PA back in the earlier years of my treatment...even though I never took advantage of the offering at $400 for 2 kits (based on income). Back then I believe they allowed 6 kits in the 2 year period that the application was valid for. Somebody fresh into the program may be allowed more kits now...but I was told 2 kits per 2 years by the PA rep the last time I needed to deal with them, and they weren't hospitable in any way shape or form. That same attitude from the PA department was confirmed when I spoke to my doctor last week, when I asked about whether or not Medicare was still covering the treatments. I believe the conversation went along the line of "They're not doing anything more than the 2 kits every two years. They would rather charge me full price for the material than help the patient.."

LATE EDIT: Now I remember how it goes. 6 kits (12 vials) during the initial two year application period. Then you only get 2 kits (4 vials) every two year application period afterward for maintenance.

[Miss Philicia]

LATE EDIT: Now I remember how it goes. 6 kits (12 vials) during the initial two year application period. Then you only get 2 kits (4 vials) every two year application period afterward for maintenance.

I'll follow up on what my doctor says when I get the next refresher. I just had one done in May and they were the last 2 vials from the Dermik stock so I had to fill out new forms, and that's also how I knew that the company entity had changed.

I could probably survive on 2 vials/year if that is true, but I had a fairly detailed conversation with my doctor and he did not articulate what you stated up above. I went 17 months before ever getting a refresher.