April 8, 2011
Sign-On to Support an Increase in Medicare Reimbursement for Facial Fillers
A prominent AIDS activist is asking people with HIV and the organizations that serve them to sign on to a letter asking the agency that sets reimbursement rates for Medicare to boost the rate it offers doctors to administer the facial fillers Sculptra (poly-L-lactic acid) and Radiesse (calcium hydroxylapatite).
Activists thought they’d won a major battle when the Center for Medicare and Medicaid Services (CMS) announced in March 2010 that the government health insurance program would begin covering the costs of Sculptra and Radiesse for people who have psychological trauma due to loss of fat in their faces, a condition known as lipoatrophy or facial wasting.
Sculptra and Radiesse are both temporary facial fillers that require touch-ups at least once per year for most people. The retail cost of a vial of Sculptra or Radiesse usually tops $500. As most people need a minimum of four to six treatments, and as doctors charge about $500 to $900 to inject the filler, a full course of treatment can easily exceed $4,000.
It’s the latter point, reimbursement for the physician’s fee, that has Nelson Vergel, a longtime AIDS activist from Houston, and other activists up in arms. Though doctors typically got $500 or more per treatment from their cash-paying patients to inject the facial fillers, Medicare is typically reimbursing only about $80. Obviously, the math doesn’t add up.
“The cost of acquiring and administering the product is higher than the payment amount set by Medicare,” he explains in the letter he’s asking people to sign on to. “As a result, physicians are not accepting Medicare payments for this service, and patient access to these effective therapies remains quite limited at the current reimbursement rates.”
To sign on to a letter demanding that Medicare increase its reimbursement rate for Sculptra and Radiesse treatment, click here before April 18.
Search: Sign-on letter, Medicare, reimbursement, facial filler, facial wasting, lipoatrophy, Sculptra, Radiesse, Nelson Vergel, CMS
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comments 15 - 22 (of 22 total)
David Chaille, Long Beach, 2011-04-14 01:17:14
The current reimbursement rate is undermining the availability of the treatment. Doctors are losing money.
Fred, Durham, 2011-04-14 00:54:25
I am one of the people who needs the facial filler. I have had full-blown Aids for 15 years. I have no medical insurance and I have had AIDS for 24 years. I worked for most of those years until I became disabled. I am doing everything I can to pay for medicines and live with AIDS. I have lost most of the fat in my face so people can now tell that I have AIDS
Newton Butler, Oakland, 2011-04-13 20:26:03
It's vital to provide quality of life improvement to those of us with disfiguring secondary effects of both the disease and the medications used to treat it.
Kelly Connell, San Diego, 2011-04-13 20:08:13
More money is needed
Richard, Jasper, 2011-04-13 12:37:26
Thanks for trying to get Medicare to increase this. I was able to get one treatment that worked great for awhile, at $500 a pop thanks to the generosity of a good friend, but now my face has shrunken back to me looking like a freak again since I can't afford to pay for these treatments myself. Sigh.
Jerry, Fredericksburg, Virginia, 2011-04-13 11:01:39
This would be great BUT in Virginia and most of the docs I called in Maryland and D.C. they do or would not do facial filling fillers especially if Medicare was involved and beleive me I need it badly buit in Virginia as usual NO HELP
David Chaille, Long Beach, 2011-04-12 20:35:42
Due to the excessively low reimbursement rate for facial fillers, doctors are losing money with each HIV patient treated. Many doctors are considering dropping Medicare. Most HIV patients experience severe depression in the presence of lipodystrophy & the associated social stigma. The savings to Medicare from the low reimbursement rate for facial fillers is more than offset by the increase costs to Medicare for psych drugs, counseling & therapy. The emotional impact to the patient is enormous.
Marc Forderhase, Dallas, Texas, 2011-04-12 09:38:37
comments 15 - 22 (of 22 total)
I would be to have my face put back like it was if I could afford it. It is ashame what POZ people have to endure.
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