When having insurance doesn’t pay: Robotic Prostate Surgery

When I first started this blog I tried to be fair about my views on different subjects, but also to be positive about them.
This is my first negative post and it has to do with the power of HMOs and their ability to prevent their patients from access to some technologies.
Patients every day ask me if their robotic prostatectomy for prostate cancer is covered by insurance and the answer is almost always yes.
Unfortunately this isn’t the case throughout the country. A new patient of mine is flying across the country to have me perform his surgery. Half of the reason is because I am good at performing the surgery and have good results, but I am afraid to say the other half is because he can not have the surgery in California through his insurance plan.
Although there are many articles in the literature that support the use of robotics in urology, some insurance carriers still call it experimental and will not cover it.
The FDA approved robotic surgery with the daVinci robot for prostatectomy for prostate cancer in 2001.
My personal experience has consisted of over 200 open prostate cancer surgeries while in Indiana and New Jersey, as well as over 130 robotic prostatectomies in the last 17 months (my entire 9 man group has not performed an open one in the same time frame).
I can do the surgery well open or robotic, but feel the robotic is a far better procedure than open and will not perform an elective open prostatectomy for prostate cancer.
My reasoning as such:
With robotics, none of the 130 patients have been given blood and I haven’t asked a patient to donate blood as we did with open since the 3rd operation.
The hospital stay has been cut to 24 hours for 93% of the patients, with only 1 patient in the last 100 going home after 2 days.
Most of my patients have resolution of their urinary function within 2 months and many are having erections in 2 months as well, which is much better than what I saw with open surgery.
To me this translates into a better operation.
It is unfortunate that patients that have insurance and think they are covered for all reasonable conditions are being denied in network coverage for their prostate cancer.