When having insurance doesn’t pay: Robotic Prostate Surgery

When I first started this blog I tried to be fair about my views on different subjects, but also to be positive about them.
This is my first negative post and it has to do with the power of HMOs and their ability to prevent their patients from access to some technologies.
Patients every day ask me if their robotic prostatectomy for prostate cancer is covered by insurance and the answer is almost always yes.
Unfortunately this isn’t the case throughout the country. A new patient of mine is flying across the country to have me perform his surgery. Half of the reason is because I am good at performing the surgery and have good results, but I am afraid to say the other half is because he can not have the surgery in California through his insurance plan.
Although there are many articles in the literature that support the use of robotics in urology, some insurance carriers still call it experimental and will not cover it.
The FDA approved robotic surgery with the daVinci robot for prostatectomy for prostate cancer in 2001.
My personal experience has consisted of over 200 open prostate cancer surgeries while in Indiana and New Jersey, as well as over 130 robotic prostatectomies in the last 17 months (my entire 9 man group has not performed an open one in the same time frame).
I can do the surgery well open or robotic, but feel the robotic is a far better procedure than open and will not perform an elective open prostatectomy for prostate cancer.
My reasoning as such:
With robotics, none of the 130 patients have been given blood and I haven’t asked a patient to donate blood as we did with open since the 3rd operation.
The hospital stay has been cut to 24 hours for 93% of the patients, with only 1 patient in the last 100 going home after 2 days.
Most of my patients have resolution of their urinary function within 2 months and many are having erections in 2 months as well, which is much better than what I saw with open surgery.
To me this translates into a better operation.
It is unfortunate that patients that have insurance and think they are covered for all reasonable conditions are being denied in network coverage for their prostate cancer.

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19 Responses to When having insurance doesn’t pay: Robotic Prostate Surgery

  1. Mike Boots says:

    I am the patient Dr. Savatta referred to. My recovery has been nothing short of remarkable. We are still planning to go after Kaiser for reimbursement. This ordeal took a lot out of us both emotionally and financially but at least I don’t have to worry about treatment. I am confident that we will ultimately succeed in our battle with Kaiser but at least I can work on it while I’m healthy.
    I get emails all the time from people in the same boat as me. They are scared and confused. I am devoting some of my recovery time trying to help these new friends. So far I have a large collection of emails from grateful individuals.
    Mike Boots

  2. Ted says:

    I contacted PCRI.org (prostate cancer research institute) and Harry says Kaiser Sunset (Dr. Jon Kaswick) got a surgical robot about 9 mo. ago. I will see him next month. Some of the men in our Kaiser support group had good outcomes with the manual laproscopic method at Kaiser Harbor City.

  3. stella stine says:

    I am trying to get any info. about robotic prostate surgery performed by any physicians at a Northern California Kaiser Permanante facility. Any information, please!!!!
    Thanks so much

  4. Ross Bouchet says:

    I was recently diagnosed with prostate cancer. I am only 45 years old. A doctor at Kaiser Panorama City claims the robot is for surgeons who do not have the abilities that he has. I recently asked to seek a second opinion with Dr. Kaswick. Does anyone know if he has been performing the robotic prostatecomy. If so, is this procedure at Sunset now covered under insurance? Thanks

  5. Mike Boots says:

    Ross and Stella,
    I’m sorry to see that the 2 of you are struggling with this same difficult situation with Kaiser. My wife and I spent an incredible amount of time researching this subject and filing appeals with Kaiser and ultimately the DMHC in California. I am not aware of any Kaiser facilities in California that offer the robotic prostatectomy. We found 2 facilities in the mid Atlantic region offering this surgery. One at George Washington University Hospital thru Dr. Hal Frazier and the other through Dr. Steven Guarnaccia at Inova hospital in Fairfax, Virginia. I understand that as of 1/1/07 Dr. Frazier is no longer with Kaiser but he is still at GWUH. I know of two northern California Kaiser patients who were successful at getting their robotic surgeries covered by going through these two doctors. Both contacted the Mid Atlantic Kaiser customer service number and request a temporary 90 day membership for the mid Atlantic region. Both received these temporary memberships and scheduled exams with one of these doctors. The doctors agreed to perform the surgery and they were not billed. Both have told me that they have zero balance due on their surgeries. I attempted to force this issue in one of my appeals stating that if this is permitted then why am I being denied documented approval of this process. I never got an answer. I don’t know if this will still work but it wouldn’t hurt to contact them.
    Another possible avenue is that I am told that Kaiser is considering outsourcing this surgery to other hspitals. I was told that Dr. Gregory Marshall at Kaiser in Pleasanton, California is spearheading this outsourcing but have not confirmed this.
    If you try to fight Kaiser I can assure you that an uphill battle is in front of you. Most important is to get healthy and not worry about the logistics too much. I got very hung up about right versus wrong and ended up making mistakes in my fight.
    The final decision to just pay and get the best possible treatment which I received from Dr. Savatta was an expense I will never regret. I have 6 tiny holes and wore a pad for 2 days after the catheter came out but discovered it was always dry (no incontinence). I am not impotent and require no pills, pumps or injections (no impotency), it all works natural. And I had a great tax writeoff this year. We will continue to pursue Kaiser but time is now on my side.
    If I can be of further help don’t hesitate to contact me at pompa1@yahoo.com
    Take care,
    Mike Boots

  6. CHUCK says:

    DOES ANYONE KNOW IF THERE IS A KAISIER HOSPITAL IN COLORADO THAT OFFERS DA VINCI ROBOTIC SURGERY FOR CANCER OF THE PROSTATE?

  7. Mike Boots says:

    It has been just a little over 1 year since my surgery and I wanted to give an update on how things are going. My PSA is still

  8. Rob Fleming says:

    I’m scheduled for robotic prostatectomy at Washington (DC)Hospital Center (not to be confused with GWU). It was the recommended choice of my Kaiser Urologist. My problem is trying to get a second opinion, about which he was not very helpful. But I read that West Coast Kaiser has a standard procedure for this.

  9. Dale Cutler says:

    I have prostate cancer. Dicovered during a TURPs procedure in Januaary of this month. My insurance is Kaiser which does not offer robotic prostatectomy. If financial possible I have decided to obsorb the cost, and looking into surgery at the City of Hope, in Duarte, CA. Does anyone have and idea of cost for the surgeon and hospital stay, a how to negotiate for insurance rates. Thanks, Dale Cutler, Simi Valley, CA

  10. Mike Boots says:

    Dale,
    Are you in Northern or Southern California? Kaiser does have a DaVinci at Walnut Creek in the Bay Area. They got it last year and it gets a lot of use. If you are interested I can help you get in touch with people that can get you more info. Send me an email and I’d be happy to help.
    If you decide that you want to go to City of Hope your best bet is to get a letter from Kaiser specifically denying you treatment with the DaVinci. Then contact City of Hope to determine cost. I remember that when my wife looked into City of Hope for me that there was a significant discount with this letter. If you want to do a self pay in southern California you might also look into UCI. They also had a discount for self pay patients.
    It is my understanding though that Kaiser has come a long way and is really pushing the DaVinci as the standard of care and that they have great surgeons using it. The problem is that there is only one system and your urologist will have to fight for you to get you in line.
    Good Luck,
    Mike Boots
    pompa1@yahoo.com

  11. Vadim says:

    DOES ANYONE KNOW IF THERE IS A KAISIER HOSPITAL IN LOS ANGELES or Southern CA THAT OFFERS DA VINCI ROBOTIC SURGERY FOR CANCER OF THE PROSTATE?
    Thanks,
    Vadim
    vibarg@yahoo.ie

  12. Paul Woodruff says:

    Hi I found your site by typing in Kaiser & DaVinci.(Love Google) Thanks for the Blog! I too have Kaiser INS, and am looking into having a Robotic Prostatectomy. Thanks for the information about Walnut Creek. I would like to use this blog to let people know what I find out.
    Thanks. Paul Woodruff
    replica@pacbell.net

  13. Robert Petersen says:

    56 y/o male, Prostate cancer patient of Kaiser.

  14. bob says:

    Look into Proton Therapy before you do anything. HMO’s do not cover it and it cost’s just under $40,000, but there are no side effects and the cure rate is exceptional.
    bob

  15. Bob Beaumont says:

    I’m writing on behalf of another. Bobby is 69. He’s awaiting what I’m certain will be a Authorization Denial as out of network to see Dr. David Ornstein for his consult for the da vinci procedure.
    Long Beach Memorial has the system and his Insurance gorup “HealtCare Partners” are apparently known for denials for this.
    An estimate on what this will cost him is:
    7,000 Dr.
    20,000 Hosp.
    4,000. Urologist?
    Sub Total: $31.000
    Being older, even in good health, has not the recuperative powers as younger men have.
    This is just insane! & you feel powerless.
    to yell then just cry.
    Bob
    bluraytech@mac.com

  16. H. Patel says:

    Does anyone know that Kaiser Permanente offer Mitral Valve (AST closure) by Robotic Surgery in any of their or their affiliated facility?

  17. ralph parra says:

    currently fighting insurance company to pay for the da vinci robotic prostate surgery – any suggestions ?

  18. Domenico Savatta, M.D. says:

    This has been a struggle for patients over the years, but has gotten better with most insurances. If you list some specifics, maybe someone can help.
    We have a program that has helped some patients over the last 3 years, but this is based out of NJ. Feel free to call my office and leave a message and I can see if there is anything I can help with if it is possible to come to NJ.

  19. cheryl martin-parra says:

    my husband had the robotic surgery in June of this is year and thankfully is doing great ! We are, however, still fighting the insurance coverage – he has Blue Cross of IL and are not covering the procedure – I have heard that Blue Cross of WI does… which I find amazing to say the least. Also his physician has told us that if the insurance company pays ANY portion he will take that as payment in full and we would owe him ZERO – that means if insurance would pay $5.00 we owe nothing – if insurance pays NOTHING we owe athe total amount. this is soooo frustrating – we have appealed three times so far and will take it to the State of IL if we have to