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Author Topic: Medicare isn't paying for my Sculptura  (Read 5471 times)

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Offline Oceanbeach

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Medicare isn't paying for my Sculptura
« on: March 20, 2012, 08:19:16 PM »
Hi Forum Friends,

When I saw myself on the local news in the "25 Years of AIDS", I became depressed as noted in my medical file.  Medicare was not paying for Sculptura.  My Provider offered to do the facial injections at no charge but I would have to come up with product.  I think it was $3000 per vial and seriously, if I could afford that, I'd have better insurance because, all Kaiser patients living with HIV were offered treatment.

When I moved to San Francisco and met with my new provider at UCSF, he referred me to the cosmetic surgery department where I got my first treatment.  On the way out, the insurance coordinator asked me to not make an appointment for the second treatment until that session was paid by Medicare.

I call every few months and talk with the Insurance Coordinator and a lovely lady in Physician Billing, it has been over a year, Medicare was billed twice and nearly $8000 has not been paid.

So, I'm wondering if any other Forum members have had Sculptura in the past year and was it paid by Medicare.  ;D  Have the best day

Offline Miss Philicia

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Re: Medicare isn't paying for my Sculptura
« Reply #1 on: March 20, 2012, 08:32:25 PM »
The place I go to uses the patient assistance program with the company that manufactures Sculptra, so the product is free for those that qualify financially. I pay $50 per injection session to the doctor for his services, which obviously for a doctor's fee is significantly discounted and reasonable (though not cheap on my income particularly).
"Iíve slept with enough men to know that Iím not gay"

Offline Oceanbeach

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Re: Medicare isn't paying for my Sculptura
« Reply #2 on: March 20, 2012, 09:29:15 PM »
I love Phylatio  ;D  Have the best day

Offline Wade

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Re: Medicare isn't paying for my Sculptura
« Reply #3 on: March 21, 2012, 12:45:03 PM »
Hi,went the new fill , later marketed as Sculptra many years ago,was on a sliding scale,I paid almost full price as I was still working,and insurance didn't pay, only lasted about one year,last year,used some savings and got two sessions of artfill,was more expensive,but is supposed to be permanent.It is the same as another filler not yet approved in USA,only difference is it's mixed with bovine,which you are tested for reaction one month prior.I am VERY happy with the results,face looks natural again.57 years young,diagnosed in 1995.
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Offline Miss Philicia

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  • celebrity poster, faker & poser
Re: Medicare isn't paying for my Sculptura
« Reply #4 on: March 22, 2012, 11:37:40 AM »
It's been 15 months since my last injection -- I think I had 3 sessions total, maybe 4 initially spanning from Sept-Dec 2010. I think I should have at least two vials left over at my doctor's office for a "touch up" before I can re-apply for a new supply from Dermik Pharmaceuticals. You can re-apply every 24 months.

btw Michaelangelobeachboy: here's the Dermik patient assistance information. But you will probably still need to find a doctor that is willing to jump this hoop with you, and like I said this doesn't cover the actual doctor's office time. I think you said that you have moved back to San Francisco didn't you, or did I read wrong. But if you have surely there's someone there that works with this program and you should be able to sniff it out from an ASO.

ps: that said, even needing a touch up is borderline not necessary for me right now, I'm still satisfied with how it currently looks. Sometimes I think I need some more but not always. Half of what I'm seeing is just saggyness from being 47 now.
« Last Edit: March 22, 2012, 11:43:22 AM by Miss Philicia »
"Iíve slept with enough men to know that Iím not gay"

Offline Oceanbeach

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  • Posts: 3,565
Re: Medicare isn't paying for my Sculptura
« Reply #5 on: March 22, 2012, 08:29:15 PM »
 ;D  I love Phylatio,

Thank you for the link.  I remember your pictures and Damn, you are a Hot man!  I stopped being case managed years ago when Sonoma lost it's funding.  Our ASO also lost their State funding while the client list has risen from 450 to 650 in the past 5 years.  Having served on all those committees, I knew my way around the roster of services and became my own case manager.

Through my volunteer work and the internet, I know several of the HIV non-profits and am not case managed.  The charges for the UCSF Plastic Surgeon were a little over $600 for on session and 6 were recommended.  Having always been a beach blanket bimbo, I am narcissistic and my depression over facial wasting has been noted in my medical records in two of the four HIV clinics where I have been treated.

My Provider thought Medicare had begun funding this service. The Insurance Coordinator at UCSF also thought Sculptra was approved by Medicare.  They approved Sculptra treatment for 7 people who were disabled by AIDS, living below poverty level and the other 6, signed an agreement to pay if the insurance didn't.  At Intake, I refused the financial responsibility waiver and was clear that if Medicare does not cover this service, there was no way I could afford it.  I am not being held responsible for payment and would like to help them get payment for myself and the other 6, so the clinic would finish the work on all of us.

What I'm hoping to find is a few people who live in any state, have Medicare and that Medicare paid for their Sculptra treatments.  I would forward our thread to Will, the Insurance Coordinator and Barbara, a lovely woman in Billing who lost her brother to AIDS.  Maybe it will help...  ;D  Have the best day


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