Going with Focal Laser Ablation for BPH

As far as I know medicare does not cover FLA. Yes the procedure is about $20K depending on who does it.

I just spoke with a lady from his office. Medicare does not cover the cost although they or private insurance might pick up some of the charges after the fact. The cost is $21,000.

My Blue cross is covering my fla for bph. Although Dr. K is not a perfered provider and will only cover 50%. Ill take it.

Hey Jim thst is great news. Did you do anything to get pre approved? They paid for my MRi but I didnt expect them to cover anything else.

​thanks

Jim that is absolutely fantastic. I am so happy to hear that. This will help.

Just sent in the cpt codes. They sent me back that it was approved.

Definitly will help. It was 20,000. grand cash. The insurance company cost is 28,000. grand. Just have to wait and see what they give me back.

Jim

Thst is great news for all of us . Thank you for sharing. 

That's amazing! Well done! My NY state Obamacare insurance is useless, No chance for me :-(

But would spend it again if I had to!

Really!!!!

That's a game changer for some. You mentioned cot codes. Can you tell us what they are?

Yes I will let you know cpt codes when I get back home...

So, Jim, correct my math if it is wrong but 50% of $28K is $14,000 from insurance and your bill being $20 K would mean a net cost of $6,000? That is less than the cost of PAE and FLA works!! Unckle is very correct this is a game changer. 

Yes 4j. No sure how it works, but I'm assuming that the insurance will go off the 28 g. So that's 14g. But I have to figure in deductible plus what ever bs Blue Cross comes up with. Hoping I get 8 to 10g back. Anything more will be a bonus. I am totally surprised they are covering any of it. Before I went in for Fla I thought I'd give it a shot for pre autheration.. Very glad I did.I am keeping my fingers crossed they don't try to pull a fast one. I did get a letter it was approved.

Jim

Laser Ablation of Prostatic Tissue Cpt 52647

Mri Guided for needle placement Cpt 77021

Mri montitoring of tissue ablation Cpt 77022

Visalase Urological Kit Cpt A4649

Iv Conscious Sedation Intial 15 min Cpt 99152

 

These are the codes I used for pre approval.

Thank you. Do you know off hand if those codes are universalor insurance provider specific.

They are universal. I received the same ones from Dr K and used them in my futile attempt to have my NY state Obamacare insurance cover my FLA. 

Hey Ross,

Day 15 hanging in. Seems slow to heal, but thinking positive..

Jim

Hey Jim,

How are you feeling? Yeah it's a slow heal and more do remember, it's 2 steps forward and one step back. I seem to have experienced these wonderful improvements only to have symptomatic setbacks the next day or that very evening. My advice (from my own experience) is to look at how you're doing a week at a time. The first week out of the catheter was tough as there was so much swelling and you can really feel it as you pee. But rest assured, it does get better.

Yesterday was 4 weeks post procedure and I am peeing 200-300ml at a time and regularly going 3 hours or more between voids. My stream is getting better all the time and this morning was nothing short of remarkable. It's been so many years since I peed this well and there's more healing to come.

So be patient and it will get better and better. I was a little disillusioned at times by the pace of healing but in the scheme of things, it's really quite quick and totally painless.

Hope all is well and keep us posted. if you want to PM me with some private questions, be my guest.

Ross