Insurance Coverage for Vaginismus: What is covered and what is not covered

Insurance coverage improves for vaginismus patients

I have noted a shift in insurance coverage for my treated vaginismus patients. Whereas in past years insurance coverage for treated patients was sketchy and almost “the luck of the draw”, I am quite pleased that most of my patients are now getting at least partial reimbursement.

What is covered by insurance?

What is covered by Insurance for Botox for VaginismusVaginismus is listed as a “sexual pain disorder” in the DSM –IV (American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders. Washington D.C.) Our Botox Treatment for Vaginismus research has been approved by the FDA. Reimbursement is varaible but continues to improve as the insurance companies realize that because of the efficiency of this technique, it is actually less costly than long drawn out therapies that don’t work. Our patients are unsuccessfully treated for an average of over seven years before being treated by us. Further treatment is usually not necessary in the Botox treated group.

While some insurance companies may not cover the entire procedure, there are usually a number of elements that are covered. An example of components which may be billed, include:

  • Review of submitted questionnaires by Dr. Pacik.
  • Dr. Pacik’s initial telephone conversation with you to review the forms and answer questions, or for local patients, the consult itself. [Here, a referral from your doctor can be helpful]
  • Ongoing dialogue with Dr. Pacik
  • Treatment. This is broken down as follows:
    • Initial “face to face” consultation
    • The treatment itself, itemized into: examination; injections of Botox; injections of a long acting local anesthetic and progressive dilation under anesthesia; time spent in the recovery room with supervised dilation by the nurse; post procedure day one face to face counseling which is estimated to be about 5-6 hours discussing dilation techniques, transition-dilators to intercourse, and primer on sex counseling; post procedure day two continued discussion of above which is estimated to be about four hours.
  • Post procedure follow-up with review of daily logs.

What is not covered by insurance?

There is considerable variability to what is covered and what isn’t. Efforts are being made to educate the medical directors of the various insurance companies as to the importance of the various parts of the procedure. The end result is that many parts of the procedure are covered fairly well.

How can you determine insurance coverage before your Botox treatment for vaginismus?

Dr. Pacik’s office does not handle insurance claims but has contracted with a third party service, Diane Tremblay of DMT Insurance Billing Services, LLC to handle all insurance inquiries and claims. Diane has been an amazing advocate for my patients. She can help determine coverage by getting a “pre-certification” reading from your insurance company and getting an understanding of what is included and what is excluded. After treatment she submits all the necessary documentation. She has done very well representing our patients and we continue to be more and more pleased. Diane has 25 years of coding experience with medical insurance and has been working to help our patients get reimbursement since July 2012. Diane has done an excellent job representing our patients and many of them have received insurance reimbursement for their Botox treatment for vaginismus. Diane Tremblay has created a Welcome Letter describing her services which we have included on this website which I urge you all to read.

Summary

In summary, insurance coverage for the treatment of vaginismus has improved considerably. Diane Tremblay has done an excellent job representing our patients.

Our office will supply you with a copy of Diane Tremblay’s Welcome Letter and Billing Information Checklist, her phone number and her email address; just fill in the Contact Form and request Diane’s information in the Comment field.