radiofrequency denied by blue cross

[niki]

Hi to everyone. This is a first post. A little history: 1982 my wife gave birth to our daughter, and was damaged with forceps. Sutured up, later developed scar tissue. Dr. used silver nitrate to burn scar tissue, but burned good tissue as well. Had reconstructive surgery, but pudendal damage was done and she has been on disability ever since. Has tried a lot of treatments from meds, nerve blocks, pain management, psychotherapy, accupuncture,chiropractic, etc. Best results from Dr. Jordan in Santa Monica but since he no longer takes medicare, we have to wait and hopefully get some more money.2007, I was advised to get a prostate biopsy as my psa went from 2 to 4. Figuring testing is always a good thing, I went. From that afternoon, I had intense pain. Felt like I was hit across the low back with a baseball bat, was spun around and kicked in the groin. Took 18 months and 14 doctors to finally diagnose pudendal nerve damage and obturator muscle damage. I have all the classice symptoms discussed here and been through the same wringer. Narcotics, therapy, accupunture etc. Went to Dr Jordan, and got some relief but even he said I would probably have to continue treatment. I had radiofrequency rhizolysis with fluoroscope guidance. Blue cross decided to not pay as they claim this is experimental. I can't believe this as Dr. Jordan is so recognized in the field and been doing this for 20 years. And yet blue cross paid for the facility where it was done. Has anyone been through this, or have any ideas for recourse? In April I was ruled disabled, but as of yet have seen no money. Same boat as my wife, can't afford treatment. Sorry for the long post, but lots of info. I still need to post somewhere to get some help on other problems, such as sexual side effects. What category is best for that?

Thanks

niki

[helenlegs 11]

Hi Niki,
Heavens, both of you, I do sympathise. Sorry I can not give you any help with the insurance (English) but I'm sure others will be able to. I know there are people who have had a similar battle and will help if possible. Post in the welcome centre perhaps as you are new? ? or any place you think may be appropriate.
Welcome anyway
Take care,
Helen

[JeanieC]

So sorry to hear that both you and your wife have pudendal nerve problems. My understanding is that you will be covered by Medicare once you have been on disability for 2 years, but I do not know how much this will help exactly, since you say that Dr Jordan does not accept Medicare. Did the radiofrequency rhizolysis help your pain, and is this the same as pulsed radiofrequency ablation? If you are specifically seeking this same treatment again, would Dr Jordan perhaps allow you to set up a payment plan since you and your wife are both patients of his?

Another alternative is to appeal the BC/BS denial of payment and hopefully others may be able to help you with this.

[merrie]

I am a patient of Dr Jordans. He is an amazing and caring dr who is cutting egde in pain mgmt. Unfortunately this means insruance will often not pay at first for certain procedures he does since they are new to the scene. Did you have other procedures done at cast at the same time? That may be why they paid the surgery center bill. Perhaps you can ask dr Jordan to write a letter citing some sources of scientific study on the procedure and appeal? I actually have 2 procedures that he is recommending for me that I cannot have done right now since insurance will not cover. I continue to fight though as much of what he does often requires appeals and perseverance with the insurance companies.

Merrie

[niki]

Thanks for the replies. I will have to see if the rf is the same as ablation. My problem is that I have appealed, Dr Jordan has written a letter, there was nothing else done at cast and STILL they denied. I am still trying to pay off the past treatments for myself and my wife before we can get anymore. At least if they finally start my disability I can cancel the blue cross. Since Dr Jordan does not take medicare that won't help, but even with paying supplemental I will save $750 a month by cancelling a pretty useless policy

[lightmail]

Hi Niki...Did the doctors tell you how this damage happened since the pudendal nerve is not inside the prostrate..Mine was caused by a surgery to remove enlarged prostrate. When he cauterised blood vessels I think heat went to outside of prostrate and injured nerve. But this is the first time i have heard of it happening with a biopsie...Sorry this happened..Robert

[Violet M]

Niki, I'm sorry your procedure was not covered. Unfortunately, unless you can find at least 2 peer-reviewed articles supporting the procedure for pudendal neuralgia you probably don't have any recourse. My surgery was not covered and I went through the entire appeals process including the independent review at the end but since there was only one peer-reviewed article on the TIR approach they would not pay for it.

I only know of one peer-reviewed article on PRF and pudendal neuralgia but there may be more out there if you do an exhaustive search:

http://www.ncbi.nlm.nih.gov/pubmed/19461829

Pain Physician. 2009 May-Jun;12(3):633-8.
Successful treatment of refractory pudendal neuralgia with pulsed radiofrequency.
Rhame EE, Levey KA, Gharibo CG.
Source
New York University Hospitals Center, Department of Anesthesiology, New York, NY 10016, USA. ellen.rhame@nyumc.org
Abstract
Pudendal neuralgia (PN) involves severe, sharp pain along the course of the pudendal nerve, often aggravated with sitting. Current therapies include medication management, nerve blocks, decompression surgery, and neuromodulation. The ideal management for PN has not been determined. We present a case of a female with 1.5 years of sharp, burning pain of the left gluteal and perineal regions. She could not sit for longer than 10 to 15 minutes. Sacroiliac joint, epidural, and piriformis injections did not improve her pain. She had tried physical therapy, occupational therapy, massage, and acupuncture but the pain persisted. Medication treatment with oxycodone-acetaminophen, extended release morphine sulfate, amitriptyline, and gabapentin provided only minor relief and she had failed other multianalgesic therapy. She had been unable to work at her desk job for over a year. She had a positive response to 2 diagnostic pudendal nerve blocks with lidocaine that provided pain relief for several hours. This patient elected to undergo pulsed radiofrequency (PRF) of the left pudendal nerve in hopes of achieving a longer duration and improved pain relief. PRF was carried out at a frequency of 2 Hz and a pulse width of 20 milliseconds for a duration of 120 seconds at 42 degrees Celsius. After the procedure she reported tolerating sitting for 4 to 5 hours. Her multianalgesic therapy was successfully weaned. At 5 months follow-up she felt motivated to return to work. One and a half years after the procedure the patient is only taking oxycodone-acetaminophen for pain relief and still has good sitting tolerance. There were no procedure-related complications. To our knowledge PRF for the treatment of PN has not been reported elsewhere in the literature. PRF is a relatively new procedure and is felt to be safer than continuous radiofrequency. Current literature suggests that PRF delivers an electromagnetic field, which modifies neuro-cellular function with minimal cellular destruction. We conclude that PRF of the pudendal nerve offers promise as a potential treatment of PN that is refractory to conservative therapy.

PMID: 19461829 [PubMed - indexed for MEDLINE]

[Violet M]

Wat a second....here's a link to another one that might count although it's PRF in conjunction with other therapies:

http://tinyurl.com/3fu2h5v

The trick is to figure out what CPT procedure codes are covered by BCBS and then see if Dr. Jordan can code the procedure that way -- although it may be too late for that since it has already been submitted. But if you have any treatments in the future you may want to keep that in mind.

[niki]

Thanks! I will review, research and report. As best as anyone can figure, the nerve and muscle were hit with the needle during one of the six biopsies. And now, I just saw a news blurb that warned against psa testing and prostate testing including biopsies. Since psa tests are not reliable, and the inherent danger is not worth the risk no man should go through this. Too bad my doctors were too engrossed in business as usual and do more tests to promote income than they were in reeducating themselves.

Niki1