Does anyone know of a facility or board certified doctor in CA that does FLA or PAE as a BPH solutio

Gene:

Do you know if you have/had a large median lobe? I've been reading that PAE doesn't really work if you have a large median lobe. 

Hi Gene, what Medicare plan do you have that covered PAE at UCSD ? I'm also in San Diego. Will be eligible for Medicare soon. Hank

Gene,

Thank you! I'm in Northern CA but would gladly go to San Diego or La if it was the best doctor to do the procedure.

Hank,  I have Medicare B with Cigna, that covers the rest  20%.  Bills, that are $75K are still in dispute with my "Sharp"HMO, but Dr. told me that Medicare is supposed  to ver them. Some hospitals on East Cost that cover PAE claim that it's Medicare covered.  I am afraid that  Medicare Advantage plan can  deny the claim. It's complicated. There is Government mandate for Medicare to cover clinical trials but there always fine print.  I understand that a doctor in NC perform PAE for $7500 cash.  It's probably the best conservative treatment of BPH ever, if it performed right and works only on a large prostates >70-90g.  It might be expensive in some places and has a lot radiation exposure involved (close to 5-6 CT scans equivalent).  It worked great in my case. I don't think that central lobe size matters much. The whole prostate shrinks and allows the bladder neck work  properly. After 3 unpleasant weeks with frequent urination and some pain fora week, it works miracles for me.    

Yes, it was transrectal ultrasound, which confirmed what I already new from previous Urography CT scan 135 cc volume and CT angiogram mapping prostate arteries for him during the targeted embolization.  There is no good way measure the central lobe, except maybe for MRI. I had tons of tests over 10 years from my former HMO Urologist, who insisted on TURP or radical robotic operation for years. He doesn't believe in PAE and still call it placebo effect. He is very arrogant as many URo doctors are.  Dr. Picel is an interventional radiologist, not an urologist but underwent 6 month training in NC center.  I studied whatever was available for me on PAE, The latest review papers sound very optimistic.  Nobody knows how long it might last. There stable 3-years old cases. All that said, average TURP rarely last more than 5 years.  I'm a strong opponent of TURP procedure. PAE is widely used in Europe, Israel, Argentina, UK, AU, Brazil. I don't know why the surgery X-Ray room cam out $34,000 for 2 hrs of use. Dr. Picel promised that whole thing will cost less that $12K. I'm still waiting for Medicare approval of Hospital bills but am happy that didn't consent to TURP. In 3-4 years less invasive methods for BPH will be FDA approved and I will deal with that if needed. Currently, I will call myself 95% healthy on the side of prostate issues, no worse than in my 30th. 

I still hope that eventually Medicare and Cigna will cover the full bill. That's what he promised me. Currently UCSD billing is appealing  my HMO refusal to cover the cost, which is probably justified. They are mandated to cover clinical trials only for cancer or life threatening conditions, when outside of network.  There were at least 12-13  PAE performed by Dr. Picel but I have no idea how they were covered.  Many hospitals claim that the procedure is currently Medicare covered. 

Thanks Gene. Why didn't you get pre approval before PAE? I sure hope your insurance will pay up. Hank

I tried. My HMO didn't approve. Medicare B doesn't issue preapprovals.  They have a list of covered services. Technically artery embolization is covered, but question is whether it's covered for PAE.  I was told by the doctor that it was covered by Medicare for previous qualified patients. WE will see. My problem is that Medicare currently is my secondary insurance. They will consider my case after final denial from my primary HMO.  It's a bureaucratic nightmare that is going on for last 3 month. I hope that it wil be resolved somehow. $75K  is of course is a huge price to pay.