Medicare to pay for "fillers" in HIV patients

[Miss Philicia]

Medicare to pay for "fillers" in HIV patients

Tue Mar 23, 5:46 pm ET
WASHINGTON (Reuters) –

The U.S. Medicare program will pay for the use of facial filling treatments in certain HIV patients with sunken cheeks and other similar problems who are also depressed, the government said on Tuesday.

The move impacts dermal fillers such as BioForm Medical's Radiesse and Sanofi-Aventis SA's Sculptra. Merz GmbH & Co acquired BioForm last month.

The U.S. Centers for Medicare and Medicaid Services said its review of current data found use of the products helped benefit HIV patients with facial lipodystrophy syndrome (LDS) who also experienced depression. Other HIV patients with the fat-wasting syndrome will not be covered.

CMS oversees healthcare coverage for 45 million elderly and disabled Americans. While HIV is "quite rare" in Medicare patients, who are 65 and older, patients who are disabled could qualify for the coverage, the agency said.

It posted the final decision on its website at http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=234.

[GSOgymrat]

That is great news. I wish my insurance company would follow suit.

[Assurbanipal]

That is great news. I wish my insurance company would follow suit.

Once Medicare deems it medically necessary they might well be willing.  The insurers often follow Medicare coverage decisions.  It is difficult for them to legally defend their judgment that something is cosmetic after Medicare has said it isn't.

Wouldn't hurt to ask them if they will change their minds now -- probably get a better answer if they push it through their formal appeals process.  That's where the corporate lawyers get involved and actually change the rules -- until then it is often just people reading from the (old) rule book.

[Miss Philicia]

Yeah, I agree and was going to say that.  I've heard that plenty of times.

But still, you folks need to keep in mind that there's going to need to be a documented diagnosis of depression.  If you've not been schlepping off to a shrink for years you better get some time in now.

Anyway, Ford, you've got permanent Brazilian fillers.  Aren't we being a tad greedy here? _

[GSOgymrat]

Actually I was thinking more for my partner than myself, but a touch up here and there would be nice.

[pozniceguy]

I have done a little research...read the whole decision package..   and it appears that  the "depression determination " will  be left to the "treating clinician" that is doing the procedure..  specifically it states  that the recommendation to require  "separate" determination will not be required.. "  pg 16 of the decision  memo"  ......  I will discuss with my Plastic Surgeon  on the 2nd of April...

Nick

[Miss Philicia]

I have done a little research...read the whole decision package..   and it appears that  the "depression determination " will  be left to the "treating clinician" that is doing the procedure..  specifically it states  that the recommendation to require  "separate" determination will not be required.. "  pg 16 of the decision  memo"  ......  I will discuss with my Plastic Surgeon  on the 2nd of April...

Nick

Ah, I guess that's good.  Sounds like language written in to calm down critics, while in the end it will basically mean not much at all, right?  It's kind of silly anyway because I don't know a single lipo sufferer that hasn't had depression as a result, regardless of whether or not they went to see a shrink about it.

Keep me posted on how it goes, Nick.

[Oceanbeach]

I have had some had some discussion with my ID doc over the years because it have isolation issues.  He has offered to do the injections if I can provide the filler.  I received this from my Case Manager today which is the same article www.Medpagetoday.com/HIVAIDS/HIVAIDS/19296.  My Case Manager sent it to me because we were talking on the phone, our clinic is closing.  I am transferring my HIV care to San Francisco.

I am getting a copy of my medical records for the entire time, I was a patient at the Center for HIV Prevention and Care and will be checking if the depression/isolationism issue has been included in my files. 

When I was younger, I picked up a hitching couple on the Mendocino Coast, we stopped at The Cobweb Palace in Westport for a drink.  That couple was James Taylor and Carly Simon and I always thought "You're So Vain" was about me.      Have the best day
Michael