CIGNA says SCS Boston Scientific is experimental?

I can't comment on the SCS unit although we have several people on here who can.

But I did want to comment that my insurance turned down one of my medications (that I had used before) because they said it was "primarily used in veterinary medicine."

I'm sure some others will pop on to offer advice.

I'm glad you're there for your DH.





M.

Nutbut,

I also had failed rectal stapling hemorrhoidopexy three yrs ago, have had chronic pain, have tried most of the therapies listed for your husband, have been referred for spinal cord stimulator trial, and my north-florida based HMO (a bcbs affiliate) has just denied authorization for SCS. I'm preparing to appeal the denial, so I would be most interested to know how your situation turned out.

Also, please tell your husband he is not alone! I am at least one other person whose life was drastically changed for the worse by pph / hemorrhoidopexy surgery! (44 yo F) I hope to communicate further with you.

You can try the appeal, but in the end you'll probably give up as it is a hassle. I was going to get a procedure a few years back which at the time had FDA approval yet cigna denied it stating it was not FDA approved, Insurances will do that and it's wrong, over use of that not FDA approved...

I even printed paper stating it was FDA approved and still did not get insurance to budge, so even if you can prove it they will ignore you and it'll just cause a backlash of other un approved things, so let it go for now until you can get better insurance...

My doctor even wrote to them stating it was a FDA approved procedure...I will always hate "Cigna" and there's another insurance out there that is just as bad on the denial button, it's not right and nothing can be done. If insurance doesn't want to pay, they won't...I've been through it...The Military TriCare is better than "Cigna".

I remember having to appeal x-rays with "Champus" because x-rays get marked routine, even when it's not routine, I had a friend that had many bills come back denied by Champus because her x-rays were stamped routine, when they were ordered for a specific reason and she never appealed, At least I won with Champus on my x-rays...but it was heck to go through.

Anyways, many well wishes to you and I do hope you win an appeal...but it'll be a hard fight...

Hi All -

The doctor called and spoke with CIGNA's doctor and they still denied the procedure a second time.  I got quite angry with the delay and called Medicare to see if it's a covered procedure.  Lo and behold, it is!  He only had Part A so I got him enrolled in Part B and what happens is that they will pay 80% of the covered amount minus our $147 Medicare deductible.

We've been praying this will work as it's about the only thing left to try out of the myriad of procedures he's gone through.  The trial is on 8/19.

FloridaHuman: - thank you for your note.  I will tell him that he is not alone.

By the way, I found a wonderful booklet (free) online by a doctor (Forest Tennant) who has an incredible amount of understanding in regards to chronic pain. I printed it out for my husband and he brought one to our family doctor as well.  Here is the link:

http://www.foresttennant.com/pdfs/Intractable-pain-guide-to-pain-free-hours.pdf

Take care all,

Nancy

Many prayers and well wishes and I wish your husband a very successful outcome...please keep us posted as we do care...

Hi All,
DH had the permanent Boston Scientific implant put in on 10/9. The rep put in settings during recovery which had to be adjusted the following week. As of today, he will be heading down to UCI to see if they can get the stimulation to be further down as the pain is more in the rectum. Since the leads (2) were put in via retrograde position, they should be able to provide full coverage to that area.

I have a few questions. We were initially told that the Boston Scientific reps can come to the house for adjustments. Apparently they have stopped that. We have to drive down to the pain mgmt clinic at UCI to meet the rep and have adjustments made. I haven't yet discovered what the reason is for that but I intend to. It's a 2 hour drive down there and DH is uncomfortable driving on the freeway so he takes surface streets if I can't take him there and I work full time and have elderly parents that need me to take them to appointments as well.

What is your experience in having adjustments made - do you have to drive to an office or do they come to you?

All in all - the SCS is helping although he is a little frustrated right now. He would like them to begin the adjustments from the bottom and then slowly go upward.

How often are adjustments usually made?

I'm also wondering about the charges? Is there a charge each time there is an adjustment? UCI normally sends us 2 bills. One is a bill for the doctor's service and the other is a bill for the facility. With the I adjustments, I'm wondering how it works.

I hope everyone is doing well.

~Nutbut

Susie - Thank you! I will keep everyone posted on this. He now has 3 implants....both hips and the SCS. My bionic husband!