Insurance Revisited (July 2013)

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    Hi ladies. Dr. Pacik was recently asked to participate as a “Guest Author” on Jane Murphy’s vaginismus blog:

    In his posting, the issue of insurance coverage for vaginismus treatment was re-visited and is so very important:

    “A frequently asked question concerns insurance coverage for vaginismus using the Botox treatment program. Since there is much more to treatment of vaginismus than injecting the spastic muscle(s) with Botox it follows that a delineation of treatment plans will be helpful in getting coverage. Many of my patients have failed to make progress using dilators. For severe vaginismus, dilation can be a form of torture! Little to no progress is made despite the support of physical therapy and counseling. Nevertheless this is covered by most insurance companies. It is for this reason that progressive dilation under anesthesia, as a part of the Botox treatment program for vaginismus, is carefully documented in the operative summary. In addition counseling is frequently covered, and the counseling we do as part of the program is also delineated as part of the medical record. The counseling includes instruction in using the dilators effectively to help stretch the vaginal muscles and transition to intercourse. This is made easier because of the Botox injections. Most of my patients are able to achieve pain free intercourse within weeks of the treatment. Though the Botox injections may not be covered, enough information is provided regarding other forms of therapy during the treatment program that often patients receive about 1/2 to 2/3 insurance coverage. We work with Diane, an experienced third party insurance biller, who has been very effective in helping women with vaginismus get reimbursement. She can be reached through my office in Manchester, NH at 603 669 0290.”

    There are several additional posts concerning insurance coverage for vaginismus treatment. One of my favorites is a post from the husband of one of Dr. Pacik’s previously treated patients:

    “We were fortunate that our insurance covered Dr. Pacik and his office. His practice was in our insurance network! When we had our procedure done, a wonderful lady named Diane Tremblay filled the insurance for Dr. Pacik’s office. She was awesome! She made sure that we would get as much of a refund as possible. We had to pay up front for the procedure, but in about a month, we got our insurance reimbursement. After going to Manchester, and meeting the wonderful staff, I would have paid for the procedure regardless if the insurance covered or not. The work that they’re doing is remarkable in my opinion.”

    In a prior post, we discussed how insurance may be now more likely than not to cover the procedure based on the new DSMV name for vaginismus – genito-pelvic pain/penetration disorder. What other questions do you have regarding insurance coverage? To the veterans, what has been your experience receiving insurance coverage? Has anyone taken out a private loan (i.e. through CareCredit, etc.) and then paid this back with your insurance reimbursement check? I would love to receive your comments and feedback here regarding insurance coverage for this treatment.

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