Health Organization for Pudendal Education

seawalker wrote:Dr. marvel does not except insurance if you are a male patient.

Is that even legal ??? I suppose it may be due to some insurance coding issue, like he is contracted with insurance as a Gynecologist and cannot code a male for "gynecological exam"...On the surface though it sounds like straight up discrimination.

Jason,
Glad you got this straight. I just got back from Dr. Marvel's and that is what Gwen told me ( I asked about new patients and she said if it was a man they did not take insurance). So sorry to hear this though. I guess it must be even harder to get the PN stuff approved for the guys. I hope all the info improves soon for the future folks and best of luck to you.
Janet

Definitely not fair! But I am going to call the insurance company anyway.Thanks so much for asking Janet I had my wife call to make an appointment, after taking her insurance info they asked for her name. She then said the appointment was for her husband (me). At that point the lady explained that it was to difficult to get claims paid for a male patient. Nice of her to tell me.

BTW, I see you said you had botox. How did it help your pelvic pain/spasm? I am trying to decide if I should have it done next month. Im a little worried about incontinence issues because I already have a sense of urgency and run to the bathroom as it is.

Jason

janetm2 wrote:I just got back from Dr. Marvel's and that is what Gwen told me ( I asked about new patients and she said if it was a man they did not take insurance).

HerMajesty wrote:Is that even legal ???

I'm having a tough time swallowing this one. How can this be?!?!?!

Jason,
I am with you, Her Majesty and Karyn on the injustice of it all. Unfortunately fighting city hall is not always possible and it seems like with Botox more studies, proof, trained people, etc is needed before evetything is paid as with other medical issues. So onto some way I may be able to help. The Botox was specifically for the pelvic muscle spasm (was diagnosed as levitor syndrome for thr levitor ani muscle I believe). In 2007 &2008 the EGS treatments worked but not 2010. All of this was done by the colon rectal specialist Dr vincent Cifello I was seeing. After that pain went away I still had pain so then I went the pelvic pain route and wound up finding out I had PNE. I had no side effects or problems from the Botox. The Blue Cross Blue Shield said the Botox was not appropriate for my ailment and denied both Howard County General Hospital's $1000 and Dr. Cifello's $500 charges but said I did not owe anything I think because they were in provider network. I had to get BCBS to send another special note to the hospital reiterating I did not have to pay so the billing would stop. Dr Cifello actually never sent me a bill for the botox. BCBS did pay the other misc expenses for the hospital stuff and I paid $109 for my side of those. That is all I can think of to say but keep the questions coming if I or anyone else can help we are here for you at least to support and learn from our experiences even of we can not change the system. FYI update on my behalf is that I found another Doctor (Adashek, gynecologist) that understands PN/PNE and gave me an acupuncturist to help me, suggestions for mental health to guide those at work that I can go to for free and I can go on work time as well as he said he can help with disability if it comes to that. With this and he can pick up meds and paperwork needed for work I should be able to leave the pain/rehab group that really only could help with disability. Starting to think there is hope. Thanks for listening.
Janet

For the record, my insurance company will reimburse me for Dr. Marvels charges since he is in my network as Janet pointed out.
However should I require expensive procedures or surgery I am going to need one of those special black member American Express cards for high rollers, as i own no house to mortgage!

I am very skeptical of this man now, but I will see him on the faith from you, and well, i am desperate to get a life back lol!

Janet, thanks for the info and taking the time to explain about the insurance. I hope you find some relief from your surgery and get your work situation straight. Yesterday I filed a reasonable accommodation request for a telework arrangement. Something else to consider if you havnt done so.

Jason,
Thanks for letting us know what is happening. I am glad you can get some payments from insurance. I can let you know my surgery costs that he submitted to the insurance - not sure if that is the regular charge but may give you an idea. I understand your skepticism and I can only say I believe he did a good job on surgery but I am only partially recovered. You may need another doctor to fill out paperwork if need more time off than he feels but if you are able to telework despite some pain that may help and offset Marvels lack of support paperwork wise post surgery. Telework would be another challenge for my boss that may not be possible given my work role (project manager) and limited external work. She is just getting over the leave bank and advancing leave, etc. For you I think you would have to travel a ways to get a doctor that takes insurance but then also maybe you would be less skeptical of him and that would offset travel costs (these may also be less than Marvel out of pocket!). Keep us posted and good luck and humor to you.
Janet