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What’s the “Cost” of a Mesh Implant: Are Mesh Victims Re-Victimized?

What’s the “Cost” of a Mesh Implant: Are Mesh Victims Re-Victimized?

October 8, 2014

Implant codes are attached to a patient’s operating room report/chart and submitted to the insurance company and how the hospital and the surgeon gets paid.
CMS (Medicare/Medicaid) determines the payment schedule (usually the lowest price paid to the hospital and surgeon for the implant). Private Insurance payments are usually (90% of the time higher than Medicare/Medicaid) payments. An implant is unique in that it’s paid back (depending on the contract) 4-6 times the cost of the implant at 80%. Confused yet?
Mesh implant payments as it relates to hospitals and private pay insurance carriers killing my career
Here’s an example:
Mesh Implant at 5 times at 80 percent killing my career
We need to be addressing the entire problem which includes the FDA, the device makers, the private insurance carriers and the hospitals; but you know who shouldn’t have to keep paying for a broken system? The Victims. #CleanUpYourMeshFDA 
9 Comments
  • Pastor Jim
    Reply

    Jeezus. This goes beyond inhumane and immoral. And the question becomes, then, why isn’t it illegal? Crooked docs, crooked corporations and crooked politicians conspire around one thing: M-O-N-E-Y.

    October 9, 2014 at 5:18 am
  • Janet
    Reply

    Surgeons generally love the idea of mesh implants, because they can do so many of them in a day, whereas the traditional “burch” procedure is more time consuming and takes a more experienced surgeon to perform. There’s recent research that proves that a polypropylene mesh implant is not any stronger nor does it last any longer than the traditional method. And none of the complications mesh causes would happen in the traditional procedure – complications such as mesh erosion, extrusion, infection, autoimmune disease from the chemicals in the plastic, etc etc etc. There’s really no reason for surgeons to continue to use mesh to treat POP or SUI – other options exist that are just as viable and that eliminate many of the very severe complications. It’s all about money at this point – sad, but true.

    October 9, 2014 at 1:25 pm
  • Court testimony by J&J executives in Linda Gross trial in Feb 2013 in New Jersey said complication rate was 33% for Gynecare Prolift mesh product and they put it on the market anyway. Barbarians.

    Sales strategy was, no skills needed which emboldened surgeons who would not normally consider doing the surgeries. “Instructions for Use” only state how to put it in, not how to repair the defect. Compare it to a flat tar roof that is leaking. They just pour on the tar and pray the leak stops.

    Also when the surgeon is implanting the mesh, he/she might actually be cutting through the defect being “repaired”.

    That’s why J&J took the Prolift off the market in 2012 instead of doing the mandated 522 studies. J&J/Ethicon knew they would never prove safetyyour or efficacy.

    No doctor. No hospital. No one ever ask/verified the Gynecare Prolift had been cleared by the FDA between 2005 & 2008. It was not. So thousands and thousands were implanted with the Prolift mesh with a 33% complication rate that had never been cleared for sale by the FDA. No one is protecting women!

    October 10, 2014 at 8:19 pm
  • Great slides Melayna – simple numbers, makes perfect sense. I’m just so distraught that it’s all true.

    October 13, 2014 at 8:20 am
  • Mandy
    Reply

    True. The surgeons do get paid by the procedure. However, the mesh cuts the time and allows surgeons to do many more procedures in a day. This is especially true with the TVT mid-urethral sling that is reported by AUGS surgeons as a “22-minute procedure”. The surgery to harvest and implant a native tissue fascia sling is 1.5 to 2 hours. A surgeon can earn 3-5 times as much using mesh. So there is a payoff. Many med schools (in their infinite wisdom) have reduced or eliminated training in the pubovaginal fascial sling procedure. Not smart. Teach the native tissue procedures. Manufacturers of devices are more than willing to train surgeons in the procedures using their devices.

    October 14, 2014 at 12:16 pm

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