Denied appeal for Aquablation
Posted , 7 users are following.
I was denied an appeal by my health plan insurance to get Aquablation outside . I'm 65 years old with medicare too. I can appeal again. But leaning towards switching insurance. I have a catheter in now since April 16th. I'm retired . Had been very active prior to urinary retention. Intimate like a 30 year old and preserving sexual function is very important to me. Prostate size 96cc.Was recommended HOLEP. Not interested in RE or long term incontinence that my Urologist said will an outcome. Incontinence possibly for a week or two and could last years. But there are ways to fix that. Aquablation offers me the best possible outcome for both. RE he said was definite .
I have family in the Santa Clara Valley in California.
I live 2.5 hours away.
Does anyone know of a good Urologist that performs Aquablation in that area?
My wife had a stroke Nov 3rd.She is doing fine just a little limp in her right leg. Our rehab has been disrupted due to my problem. It really eats at me cause she was getting my full devotion to helping her get to 100%. She deserves it. Has taken care of me for over 40 years.
This group has been amazing.
Wishing Stevareno a full and speedy recovery.
Thank you Mike
1 like, 14 replies
alexander56512 michael66435
Posted
What health insurance do you have?
With a pre-existing condition, I dont think any insurance will take you on, but worth a try.
If you have Kasier , my uroligist doctor here in San Francisco told me Kaiser wont do Aquabaltion for at least 3 years.
Stanford has great uroligist. My doctor did a fantasic job on me and really pushed for me to stay in the hospital 3 extra days to flush out every bit of the stuff.
michael66435 alexander56512
Posted
Hi Alexander.
I have Kaiser.
I have an appt with Stanford Urology and they are fully aware of my situation and haven't mentioned that they wouldn't take me on due to pre existing. I think Obama changed that before he left office.
Paying out of pocket is another option.
Yes that was my point to Kaiser during my appeal. Why would they let this opportunity pass me by when they already do the procedure in the Mid-Atlantic Kaiser Permanente in Maryland and it's going to be done here no doubt in my mind in a few years. My appeal letter was put together real well and looked over by Procept-biorobotic and edited with additional info. They are acting as an advocate on my behalf.
I thought I'd reach out to this group for any additional info that I might need.
I just recieved another letter today from someone that reviewd my letter and wants to further do a grievance on my behalf. Not sure what that's about. Had a busy day today and have yet to look it over.
Did Stanford Urology do your procedure? Hope your doing well and thank you for the info. Cant wait till I get this procedure scheduled and done.
I
michael66435
Posted
that doesn't make sense does it? Been a long day and I'm exhausted. Of course it's not the Urologist that decides if they would cover pre existing. But the insurance carrier that Urologist accepts. But yeah I though Obama changed all that. So we will see when I get to that point. Keeping my fingers crossed.
Steveareno michael66435
Edited
Hi Mike.
First appeal it again...Most insurance will give in bc of persistence. I know it is a pain but if you keep at Kaiser they will see that you are not willing to give in. Also get your urologist to be your advocate. They know how to talk to these doctors. Doctors review cases at insurance companies to try and deny what ever they can. PERSISTENCE is key to getting what you want.
My AQUABLATION update:
I had the Aquablation surgery on Monday, June 5 at 11am. It took about 1 hr and 45 min. I had no pain from the procedure post op. In fact the nurses kept asking if I needed anything but I did not have pain. Surgery day...I was in bed the rest of the day bc of the continuous irrigation and my doctor does a traction on the catheter (1 hr on 1 hr off) to keep the catheter tight on the bladder sphincter to decrease bleeding. I ate dinner and slept on and off through out the night. Still no pain but if the traction was moved I would get a slight bladder spasm.
Tuesday, 1st day post op: Continuous irrigation was continued till 9:30am. Dr. came in and did a manual irrigation with a syringe and normal saline and cleaned out the clots. Urine was light pink tinged. Dr. then stopped the continuous irrigation and said to walk the hallways and drink a lot of clear fluids. The nurses then came in to check on the color of the urine and see that I could walk. The surgeon did not want the catheter removed for 7 days because of the size of my prostate that was ablated (182cc's). I was discharged to home with manual irrigation supplies that my wife can do if the catheter gets blocked. I have had no pain from the procedure but the BLADDER SPASMS (from the catheter moving around) are 10-15seconds in length but intense. I was sent home on 5 days of Macrobid (antibiotic) and Hycosamine/Pyridium for the spasms. The antibiotic was prescribed bc I had an infection 2 weeks before that was treated before my surgery. I am tired and exhausted but able to get around the house and eating fine. Any pushing to have a BM causes a bladder spasm and they are miserable. Thank goodness they are short in duration. Doctor said to walk and drink lots of clear fluids as that it was natural irrigation.
Wednesday, 2nd day post op: Still having bladder spasms when the catheter gets manipulated or pressure to have a BM. Happy to be home but not sleeping through the night bc the catheter leg bag fills up and needs to be emptied. All is good but I'm looking forward to getting the catheter out on Tuesday, June 13 at 8:30am.
Thursday, 3rd day post op: Same as Wednesday....
I guess I'll have more to say once the catheter is out on Tuesday. Looking forward to the results of this procedure and being able to urinate on my own. I have been with a catheter today (Thurs.) for 71 days. Can't wait to have this out of me!!
All the best to you and your wife. Hang in there Mike.
cali-mike1970 michael66435
Edited
Chris Welty in Oakland has quite a few under his belt.
Rajesh Shinghal in Fremont (Palo Alto Medica Foundation) does them as well.
The Stanford doctors do them as well.
michael66435 cali-mike1970
Edited
Thanks Mike. Good to know. I think I'm still going to press Kaiser too. But I have a few appointments in the Palo Alto and Mountain View areas that are not Kaiser Urologists.
There have been Kaiser patients that have succeeded in appealing. I'm thinking cause we moved to El Dorado County that might have something to do with it. If in fact these URO here put in their 2 cents. But again I think the Dr of panels are from San Diego. Behind the scene stuff. We are originally from SCV. None of that should matter and it might not. I have a habit of thinking outside the box.
Steveareno michael66435
Edited
Hello to all.
It has been 7 days since they removed (June 13) the 24 French Catheter that was placed into my bladder during Aquablation so that I could have continuous irrigation for the first 30 hours after the surgery. This catheter is different in that it is larger and more rigid. Very uncomfortable for sitting and it caused numerous bladder spasms over the 7 days. My Surgeon left the catheter in bc of my prostate being so large. My understanding is that most of the time the catheter is removed the day after or within 1-3 days. I, of course, am the exception.
Well...I did have urgency and frequency after the removal of the catheter. Some pink tinged urine but overall no frank red bleeding going on. Very few small thin blood clots and tissue can be seen in the urine every once in a while. Over the past seven days, I have continued to get bladder spasms on and off. I had a catheter in for 76 days in total, and it feels great not to have a catheter and bag hanging off me.
Sleep has been on and off because I drink a lot of water, green tea and two cans of beer each night plus the bladder spasms. Also, my intestines have done a bit of a revolt on me. So I have to take milk of magnesia and colace and miralax to get things moving normally. Anesthesia does mess with your intestines and it is getting better. It does make you feel a bit anxious about urinating and BM's.
All in all...Aquablation did not hurt. I had no pain other than the bladder spasms. I didn't need Tylenol or any pain medication.
I am definitely feeling better. I am able to have more bladder control than initially.
I'll keep you all posted in the days ahead.
michael66435 Steveareno
Posted
That's great news Steve! Thanks for the update. Urine flow stronger? How long till you can be intimate with your wife? That's one of my biggest concerns is RE. I'm sure if the woman had a say in the matter they would prefer AE . Mine would but bottom line is she wants whats best for me.
I can't believe we are all going through this. It's OUR PAYBACK FOR NOT HAVING BABIES!!! LOL
Hope everyday is a better day for you!!!
Steveareno michael66435
Edited
Yes urine flow is strong. I actually do better standing to urinate. Haven't done that in a long time. Feels great. I am urinating 150-200cc's quite often but I drink a lot of water and cranberry juice and of course my two beers each evening.
A bit sleep deprived d/t drinking fluids but it keeps the bladder and everything moving as my doctor and nurses have stated...drink lots of water because it is the natural irrigation to help with the healing process. That also means that I have to urinate quite often throughout the day and night.
When I had my consult with the Aquablation surgeon, I told him that I wanted to have a regular ejaculation. Retrograde or Anejaculation was not my priority and he noted as such. At the present time I do get a partial hard-on at night which usually happens when I wake up to urinate and then I have to wait till it goes back down so that I can urinate. That being said...no sex with my wife (as of yet) but what is positive is that the partial hard-on is there. I guess I am more concerned with urinating I'm not really thinking about sex at the present moment but my doctor said I would know when I was ready and able. I'll keep you posted as things progress.
michael66435
Posted
Update;
All my appeals have been denied. It seems my Health care insurance and URO just don't care to refer me out to get Aquablation so I took matters into my own hands.
Had a consultation with Dr Brubaker, in Redwood City, ca. He listened to all my concerns and had great bedside manners. Dr Brubaker was recommended as top notch in the Santa Clara Valley.
A couple weeks ago I had what was suspected as a UTI so I went in for urine culture. A previous order for a PSA test from last year that was supposed to be taken off the list was given to me by the receptionist. Having a catheter in at the time I had the feeling that would skew the test.I took the test anyways and PSA came back 8.7 from previous test 7 months ago of 5.4 followed by 5.0 decline not much and had an MRI following that test. All was clear. But since this 8.7 regardless of effect from catheter it was suggested and agreed upon to play it safe and get a biopsy before proceeding to Aquablation procedure. So my current insurance and health care will cover biopsy on Aug 7th. If all is clear than I will immediately drop current ins/health care and switch to Blue Cross Anthem which will cover my scheduled Aquablation Sept 26th. I pray that everything is clear and no cancer. If it shows PC than this will change everything. Totaly different discussion and procedure. I kick myself in the butt for not having biopsy last year. Uro said with the MRI that since all looked good that we will take a PSA in 2023 and didn't have to do a biopsy if I didn't want. I've had this catheter in since April 16 2023 and its getting to me got to admit. It sucks big time. I dream about running, working out, fishing with my son, swimming and playing with the grandkids, going to Hawaii, helping my wife get her step back after her stroke. So much to do! This down time with covid and then this prostate problem has did a number on my retirement years. All I can say is when I get right it's go time !!!
Thank you to all who have posted their experiences on not just Aquablation but all procedures and prostate problems. So valuable!!
I will update after biopsy Aug 7th.
Mavrick michael66435
Posted
Hi Mike,
Hoping you are getting help. My input would be Dr. Christopher DiBlasio in Fort Meyers, FL. He does Holep. Check out his healthgrades scores. I am a patient of his and he is great. Did Dr. Brubaker work out for your aquablation? Thank you.
michael66435 Mavrick
Posted
Hi Mavrick
Yes Dr Brubaker did a great job. I am 3 months post opp now. I was with a catheter for 7 months. Getting back in shape too fast too hard and Ive had back problems(L-4 L-5 degeneration) so backed off and strengthened the core with various stretching and exercises and back feels good and now hitting workouts pretty good. Just had a PSA test yesterday and it came back elevated 8.4. It was 8.7 pre opp so don't know if thats normal . I also had sex within 24 hrs of test and forgot I should not have sex within 48 hrs. I have a follow up appt tomorrow.
Regards Mike
mike19110 michael66435
Posted
Hi Mike:
I had aquablation ~ 2 years ago with a good outcome. I saw a urologist in New York City. A couple of things:
-Aquablation is fully approved and covered by Medicare
-I have heard good things about Dr. Craig Comiter who works out of the Bay area.
Good luck!
Mike
michael66435 mike19110
Posted
Hi Mike
Congratulations on your out come. Isn't it great?
I had my Aquablation Sept 26th 2023. I had to leave Kaiser and pick up Blue Cross Anthem with my Medicare. Dr Craig Comiter was my first choice but he couldn't see me till Oct and I wanted the catheter out asap. I went with Dr Brubaker who had done plenty of work at Stanford and Sequoia Hosp. He was highly recommended and I feel he did a great job.
The only problem I'm having is my PSA is still 8.4 . I had a 8.7 before Aquablation when I took a PSA test that I probably shouldn't have but my old URO forgot to cancel it(PSA TEST) since I had a catheter in and that would only spike the PSA.
So I'm 3.5 post surgery and I just had a 8.4 result. Down very little but I had been intimate within 24hrs and forgot It had to be 48hrs and I was working out pretty heavy recently and I also took a T-Booster for extra energy and to keep T levels up. Dr Brubaker wants a retest in 2 months with no intimacy for at least 48hrs, no supplements, no intense workouts. If its still high then he wants to run more tests, and repeat MRI, Biopsy etc.
I don't know if anyone else has had a high PSA result 3 months post Aquablation.
Thanks .
Mike J