Yet Another Journal: Insurance Woes

[OregonStrong]

Just way too many pump and tubing failures with the Titans, I've seen this too often on here. If you have a chance to go overseas, maybe Australia, see if you can get the Rigicon infla10. I'm gonna look to go that route when mine fails.

Thank you for your advice! My understanding is that it's specifically the Titan with the OTR (One-Touch Release) pump that has a high rate of early breakdowns, whereas the Titan with the Classic pump has proven much more robust. At least that's what Dr. Eid told me. I hope he's right. I'd rather not go overseas and pay out of pocket for the revision.

If the Rigicon is a superior product, I hope it eventually will come to the U.S. too – perhaps it time for my next revision!

I'm biding my time for that to happen. I think it's being reviewed by the FDA. Once it gets approved I think it's going to quickly take over the Titan market. So they really should get their act together and fix their quality control problems or they're going to lose millions in market share.

[NYCGay]

Alice’s Encounter with Cigna in Wonderland

Dealing with Cigna feels like trying to get a straight answer out of the White Rabbit in Wonderland: ask anything twice, and you’re all but guaranteed to get two different and entirely incompatible answers. Asking a customer representative if my revision surgery, for which I had the procedure and diagnosis codes, is covered, he said no. But he sounded a bit vague, so I called again and asked another representative and was told, yes, it’s covered; would you like a reference number to our conversation? Yes, please, that would be great! He put me on hold repeatedly for close to an hour, and finally came back and said: On further investigation, the revision will not be covered. Confused by his change of heart, I called a third time and asked to speak to a claims specialist. She confidently told me that, yes, procedure CPT 54410, revision surgery, is indeed covered – but the facility where Dr. Eid will perform it is out-of-network. This was contrary to what I had told before, so I called a fourth time and asked only if the facility is in-network. Oh, yes, it’s in-network; would you like a letter stating so? Yes, please. I did receive that letter, so I’m now fairly confident that the facility is indeed in-network. As to whether the surgery is covered at all, who knows? Only way to find out seems to be to go through with it and see if they pay.

[ElbowRoom]

I'm biding my time for that to happen. I think it's being reviewed by the FDA. Once it gets approved I think it's going to quickly take over the Titan market. So they really should get their act together and fix their quality control problems or they're going to lose millions in market share.

Statistically, Rigicon IPPs have slightly higher rates of failure than Titan. Look at the study user principales just compiled...it found Titan and AMS having near-identical rates of revision, which matches previous meta-analysis of studies. This surprises a lot of people.

Titan gets a bad rap because it has a known area of weakness (tubing), but that's only in comparison to the rest of the device, which is extraordinarily robust. If a Titan fails, you can bet with 90% certainty it's a tubing fracture. AMS, on the other hand, has pump, tubing, and cylinder failures. Which is better, a generally bullet-proof device where one area is less robust, or a device were all components are equally strong but generally less so? I don't know.

But with overall failure rates equal between devices, it's hard to say Titan has QC problems any more than Boston Scientific. I do think competition is good and I welcome Rigicon into the market. I do not, however, believe it will be a panacea.

Over 85% of Titans are still working at 5 years, 75% at ten years, and 50% at 20 years. These numbers are slightly higher than Rigicon's. I think with any major manufacturer we can generally expect ten years and then a replacement becomes more likely. That's similar to breast implant life, and those don't do anything mechanical except get fondled.