HIFU technology was approved by the FDA on October 9, 2015. I have personally treated well over 350 patients in Sarasota since the opening of the Vituro Health Sarasota HIFU Center of Excellence Program. So, it is reasonable to assume that since the FDA approved HIFU, then, of course, it would be automatically covered by US insurance companies since it is the latest and greatest prostate cancer treatment, Right? Well, not in all cases. Medicare has issued a facility ( hospital or surgery center) reimbursement C- code and I am now offering HIFU treatment at The HIFU Center of Excellence Program at Lakewood Ranch Medical Center. My Medicare patients can now expect greatly reduced out of pocket expenses. For more information, inquire about our Medicare Elite Access program. Cigna has announced that HIFU treatment will be reimbursed for men who have recurrent prostate cancer after radiation therapy has failed. I have had several veterans under the care of the VA Healthcare system who have been reimbursed by the VA or have had the VA pre approve their treatment. Many of my commercial insurance patients have been successful in obtaining some reimbursement from their health insurance carrier after their treatment by working with our affiliated Vituro Reimbursement Assistance Program which is available to all of my patients without any additional charges. More details on Insurance and Financing are available on this page: Medicare Coverage, financing information
Despite all of the logical reasons why US insurance companies SHOULD cover HIFU ( outpatient treatment, excellent results, low side effects, less expensive than other treatments), HIFU is still considered "experimental" or "investigational" by insurance companies and most companies still list in their medical review decisions that HIFU is not FDA approved. They do not consider that over 50,000 men have had HIFU treatment worldwide, 15 year outcomes have been published, and YES the FDA really did approve HIFU for prostate ablation in 2015.
The process of insurance reimbursement for new medical treatments in the US is a long and often cumbersome process and often takes years. This unfortunate "insurance industry" red tape and and slow pace of adoption of new technology really deprives many men of the opportunity to treat their prostate cancer with HIFU as the "out of pocket" expense averages $25,000 without insurance coverage. HIFU treatment can be easily financed at market rates with flexible repayment terms. See the Insurance and Financing section of this site : Insurance and Financing Information
I invite patients to submit a letter of medical necessity( supplied by Vituro Health) to their medical insurance carrier, but the results have been very disappointing and frustrating. Vituro Health's Insurance Reimbursement Assistance Program will assist my patients in appealing their insurance carrier for reimbursement after their treatment. Unlike other HIFU programs, Vituro does NOT charge any additional fees for this service.
Men who make the decision to have HIFU treatment accept the fact that their insurance may not cover this treatment and have decided to make an investment in their health. They want to treat their prostate cancer without enduring the serious quality of life side effects associated with traditional radical treatments like surgery or radiation. To find out if HIFU is an optimal solution for treating your prostate cancer, call the Scionti Prostate Center today at 866-866-8967