Blog: Vaginismus and Insurance Coverage

[Heather34]

Hi ladies. There is a new blog posted that discusses potential insurance coverage for the Botox treatment for vaginismus. An excerpt includes:

“It is important to note that while some insurance companies do not cover the entire procedure, there are usually a number of elements, such as the dilation program and counseling, that may be covered. Each policy is different and a pre-determination of benefits is usually a good idea. Dr. Pacik’s office does not handle insurance claims but has contracted with a third party service, Pamela Altner of PMS Medical Billing in Milford, New Hampshire to handle all insurance inquiries and claims. Pamela has been able to help patients with reimbursement for those who have “out of network” coverage.”

This is a very helpful blog to read for those patients who may be seeking insurance coverage for the procedure.

http://www.vaginismusmd.com/insurance-coverage-for-botox-treatment-of-vaginismus/

[chelsea72]

there was nothing helpful about that or the blog. the costs vary so much depending on how much you the patient is getting screwed over this week. What would be helpful to know is how much it costs- a ballpark figure, since this is a female disease and insurance has the god giving right to to ignore that half of the population.
The vial itself can cost anywhere from $400 to $ 1600 depending on what Dr you see,
Hospital bills can vary wildly from $400 , at say the uro dept, same hospital but at the pain clinic $1600 , all the way to $16,000 at another noted specialists hospital.
So how much does this procedure cost is the question that I need answered. And why isn’t the makers of botox fighting harder to get all the other non cosmetic uses approved and then , therefore covered by insurance. In my fight to get this procedure done , over 2 years now, I have found not only is botox not covered but every and everything gloves included! involved is not covered IE hospital stay, drugs used all the different doctors fees- nothing is covered if the J code is used. I have great ” out of network ” coverage as long as I don’t get botox, or dry needling, acupuncture, chiropractor, or a couple of other medically necessary things.

[Dr. Pacik]

I could not agree more that the wide range of hospital expenses is a nightmare and very unfair. It is for this reason that we have one fee which currently is $4850 + $80 for a set of Pure Romance dilators. This global fee covers all of our phone calls, consultation fees, the procedure itself, the cost of Botox, anesthesia, surgicenter, recovery room, post procedure counseling, full staffing for two to three days of care and long term follow up. The Botox itself costs me about $600 vial and between 1-1 1/2 vials are needed for a wholesale cost of up to $900. We have to pay the anesthesiologist, drugs they use, upkeep of the operating room equipment, new equipment as needed such as anesthesia machines, autoclaves and the large amount of equipment needed in the OR to ensure a safe procedure. We have monitors in the OR and next to all beds. Additionally, we have to pay surgical techs, recovery room nurses, administrative support staff, all the expenses of running a practice and insurances, of which malpractice insurance takes another big bite out of any small residual profits.

Currently the entire procedure is not covered by insurance. Botox injections are still considered experimental, even though I received FDA approval to continue my research using the Botox program for the treatment of vaginismus. Blue Cross, Blue Shield has been covering about $3300 for the treatment, though there is some variation, and also among insurance companies. Pammy who does third party billing is an excellent advocate for our patients who want to submit claims after their treatment.

Hope this sheds some light on what we are all up against.

[Heather34]

There is a great new resource article posted today which further details the cost of treatment as well as insurance coverage.

http://www.vaginismusmd.com/vaginismus/current-cost-of-botox-treatment-for-vaginismus/

[sunfish7]

Thank you for being honest about the cost of this procedure. The cost was one of my biggest fears and it really makes me feel confident that you are willing to be up front and not dance around the issue. I’m starting to feel very positive about the possiblity of having the procedure and having it work for me!