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Are you happy with your Reps and Follow Up Care??

RRraeRRRrae Posts: 85
edited 06/11/2012 - 7:42 AM in Spinal Cord Stimulation
Hello fellow SCSers
I'm doin real well with my implant and the recovery was much easier than I thought it would be. The doc did a good job.
I'm still in the 'Honeymoon' phase i spose and am still getting used to it. No complaints! :)

My Q is this:
Whose responsibility is it to organize the programming sessions and follow ups? I would assume it is the Dr office right? ok....
Does anybody have any problems getting ahold of their Rep when they need help or questions answered?

I know someone who is having problems with the implant site (which the Dr needs to fix), but the Rep did NOT show up for the re-programming. The doctor is now telling this patient that it is up to HER to get ahold of the Rep (regarding getting her coverage adjusted) and the Rep has not returned the calls. Meanwhile the Dr gave this pt sleeping pills to bide time until a new appt can be coordinated w/the Rep.

I haven't had a need to call my Rep yet, so I don't know how good of service I'm gonna get, but I am just wondering if this could end up being a case of Dr and Rep passing the patient off on each other.
Medtronics gave us a video and pamplets.....but I wasn't in any frame of mind in terms of thinking of the future, and there is NO actual paperwork whatsoever indicating any sort of guarantee that they intend to have any long term 'commitment' with us.

My friend lives in a different city than I and I don't know much about her Dr, but this is starting to look to me like once everyone got their big chunk of change, this poor gal is kinda left hangin in the breeze.

I'll get on their website and do my homework, but wanted to know if anyone has problems getting the proper attention they need?



  • It is the responsibility of the patient to contact the rep and the doctors office. Normally I contact the rep and schedule an appointment with him. He then calls the doc's office to make sure there's a free room he can use. As a courtesy I contact the doc's office as well and let the office staff know I have scheduled an appointment to meet my rep on a specific day and time. If there's a conflict on either end, we switch to an alternative day and time.

    So if I am scheduling simply a follow up for post op check in, I schedule that with the doc's office and send a courtesy message to the rep.

    If I am scheduling a reprogramming session, I contact the rep first and fit into his schedule and then notify the doc's office.

    Hope this helps.

  • I have nothing to add to C's post except for one thing. I have my normal PM Doctor where I do everything that C just said and I have the PM Doctor who did the implant. If there is a problem with the implant, then he is the one I have to contact.

  • I am a Medtronic success story, and I contact my rep directly. I live minutes from the surgery center where my pm does all of his trials and implants. Since the reps are there anyway, they pay me house calls when I need reprogramming. I mention to the doc on my next appointment that I had been reprogrammed.

    Remind your friend that she's teaching her reps/docs how to treat her, and if she wants responsive care to demand nothing less.

  • My PM would ask me if I needed to see the rep when I went in for my appointments but I could call hem anytime I wanted to see hem and he would see me at the PM's office. I did call hem twice and he saw me that same day, as soon as he got out of surgery.
    As it turned out I did not have my implant long so I do not know if his promptness in seeing me would have continued. But I do believe it would have.
    I am so very happy your SCS is wrking for you. That is wonderful.
    Cheers :H
    Patsy W
  • Well, thank you my friends! That makes things crystal clear! My docs office isn't too well at communicating (they are extremely busy), so I didn't really understand the 'politically correct' way to handle this.
    So, basically, everything is handled at the Dr's office and it's just a simple matter of me being clear on how to make the calls!

    This will certainly save me from potential confusion and frustration in the near future because I probably would have called the busy Dr's office, wanting a tweek session (that the Dr doesn't even need be present) and assumed that THEY were to schedule the Rep to come to their office.

    And thank you C - a simple 'courtesy' call to both parties is just plain good business, not to mention patient etiquette !

    Thanks guys! What a team you are! :*

    I will pass this on to my frustrated friend, and perhaps it will clear the path for her. She's in so much pain, she can't even think straight. She
    e-mailed me in tears.

    God Bless All!
  • When you arrange to meet with the Rep, do you have to pay for an office visit? I assumed that all the reprogramming sessions would be considered a courtesy or 'content of service' to the implant operation.

    My friend says she is having to pay office visits each time she gets re-programmed (the Dr isn't even there).
    Something just doesn't 'smell' right with what she is dealing with......or else she isn't conveying the facts to me correctly.

    I spose paying the doctor for HIS office visit time is expected.......
    But, do the Reps generally re-program as a courtesy, no matter how many sessions it may take?
    In my case, the Rep travels 300 miles to get to the Dr office where the implant was performed.

  • Rae

    The billing codes are set up based on whether there is a doc present during the evaluation and programming or whether it is just the rep. Here's a quote taken from the billing manual
    An office visit can only be billed separately when a full-scale, separately identifiable evaluation and management service takes place in addition to analysis and programming.
    There is a facility charge as well as a physician office charge.
    The patient or payer should not be billed for services rendered solely by the manufacturer’s representative.
    So in essence, there's no charge for just meeting with the rep, however there can be a facility or office charge. If you meet with the rep and the doc, then there's a facility or office charge and a physician charge.

    I hope this makes sense.

  • I have had several meetings with my rep from Boston Scientific since my surgery in November. Each time we happened to schedule it when I had an appointment with my pain management doctor anyway and the last time, we had a "joint" session with the PM doctor while we evaluated the placement of my stimulator and whether it was reaching the area it needs to. But my instructions are like the others, and I call my rep, directly, and find out where he is going to be and he meets me at one of the multiple offices he visits and just secures a room. No extra charge for that. My rep has been terrific through the trial and surgery. I really, really like him.
    Gosh I hope your friend can get things worked out and be more comfortable.
  • Pointless comments.....
  • My occupation is actually submitting medical procedure coding to Insurance companies..... Our wonderful Medicare system has conveniently caused much upheaval by eliminating 'Consultation Coding'. Effective at the beginning of this year It is now technically considered E&M (Evaluation & Management) and there are many stipulations on how office visits can be billed.
    Since I am not a Medicare patient (yet), this does not apply to me, but nonetheless, it gets to be a sticky situation in how facilities can bill office visits for those who are 'established patients' vs a 'New Patient evaluation'..... #o
    Thanks for making it clear that the Reps do NOT charge.

    So far, I feel good about Medtronics, I hope they stand by their product and service and keep a good reputation.

    Thanks to all!
  • I was able to read your comments B4 you edited them....they were NOT pointless!

    ........ :W take it back mister......

    your input is very valuable ! ! ;)
  • I didn't like how I wrote it, and just didn't feel like editing it. Just not myself as of late.

    Thanks anyway.

  • :( You are always here for everyone else.

    The least i could do would be able to have the honor of possibly saying SOMEthing that may lift your spirits...
    Pain? ...... ok not my business. But it IS my business to 'care'.....so........
    whatever's goin on with you, I will say a little prayer
    and hope that things get better.

    Remember, we're all in this together....and I truly value all the support you've shared since my time coming on board

    I care,
  • Thanks for the thoughts. Just having some bad days. It's all part of the program. Just wears on you sometimes. The weekend is here, the sun will be shining, and I get to sleep in tomorrow.

    Have a nice weekend and thanks.

  • Guess I am one of the lucky ones. When I need reprogramming my PM handles everything for me. But she has 3 reps that work with her everyday. Most of the time when i schedule an appt they ask if i want to have my programs checked or tweeked. Since these SCS are costly i usually have it tweeked.
  • Physicians assistant does all the programming and tells me he can take care of everything! Uh, no, I don't think he is doing a very good job of it.

    I have not called my rep as I got the impression it will cause "issues" with a PM I do not particularly like anyway.

    I also freely admit part of the problem is me and my bipolar type II. I pretty much don't give a rats #$$ about a lot of things right now, so I just don't do it. I seen my shrink in a few weeks and we have discussed attempting something different in my meds.
    We did not want to do that in mid winter as we both agreed it would be foolhardy to take away my current med that does help somewhat. Not sure I will even give it up this time. It greatly helps my pain at 75mg and everytime I drop to 50 the pain comes rushing back in, so....

    Hey, how's that for a ray of sunshine, sorry for the grumble there at the end.

    So, no, I'm not thrilled with my programming sessions and have a feeling I am being discouraged from contacting my rep so the PM can bill for every visit, that must be preapproved since he is now "out of network" a change he made AFTER the SCS implant. No, there isn't another game in town.
  • rplatt56 said:
    Guess I am one of the lucky ones. When I need reprogramming my PM handles everything for me. But she has 3 reps that work with her everyday. Most of the time when i schedule an appt they ask if i want to have my programs checked or tweeked. Since these SCS are costly i usually have it tweeked.
    Now that's the way it SHOULD be!! Actually, I'm hoping for the best, as I have yet to schedule a Follow Up, other than when they took my surgical tape off 10 days post op. I'll give my PM's office the benefit of the doubt unless I experience otherwise.

    The negativity expressed in my 1st post was mainly regarding my friend's issues.....She had some ill-fated complications, as she took a fall, which ripped the stitches inside her IPG pocket #o
    Poor thing! NOW she's having a hard time charging because it's too painful at the site. She has Lidoderm Patches to help, but she said she was gonna try charging with the Lidoderm patch on. Not sure that'll work? I'm waiting to hear back
  • Wrambler, (8) you've seen MY rants, so go for it dude! That's what this place if for innit?
    Hey, I've been all over the 'map' with my emotional upheavals.....haven't 'officially' been diagnosed with any Bipolar issues, but have often wondered about it.
    But at my age, EVERYTHING can be chalked up to the female 'midlife' thing. ...i guess i'll take that as an 'advantage' /:)
    Other anti-depressants always seemed to backfire on me, so Wellbutrin is what i'll stay with. Lord Have Mercy you shoulda seen me when i was on certain (better not name names) off-label anti-epileptics .... image:)" alt=">:)" height="20" /> for neuropathic pain issues.....I could go into some grizzly detail just to humor the board....and maybe even squeeze a smile outta Dave... :P but i'll refrain.

    Ok, not making light of being 'down and out'....
    Actually I've BEEN that way too much lately. Seems like lots of folks are. I bet it does have something to do with the fact that the sun seems to have taken an extended vacation during this long dreary winter....i do believe it's back tho,...so let's soak up some vitamin D !!

    Just having a good day (finally!), so please excuse my squirreliness...... :O)
    ok, i'm having way too much fun with the smilies.... I'll go get a life now :)))
  • What I wanted to say before i somehow got wayy off topic.....regarding the programming!!

    Wramber! It concerns me that you feel inhibition about calling your Rep!! Your Dr sounds as tho he thinks he's King DingDong, but that multi-thousand dollar unit in your hiney is the COMPANY'S property and that's what the Reps are FOR is to stand behind them!
    Why not call your Rep and talk about the issue regarding your Dr and I bet you'll get good support....Not to mention, better service for what you've been paying for .
    .....just my 2 1/2 cents ?
  • Actually, if you and your insurance paid for the equipment , it now belongs to YOU. At first, the company tried to rent it to me but my insurance carrier said NO. And once its implanted into my hiney, good luck trying to get it back. LOL. The whole solution to this is finding a PM that works with their patients and gives respect. Mine has told me if i need reprogramming weekly its ok. Matter of fact, she sort of scolded me a while back because i went 2 months without reprogramming.
  • yeah, actually i didn't really word that the way I meant to....the unit IS indeed OUR 'property' now of course. What I'm comprehending in Wrambler's case, is that his Dr seems to think (or at least gives the impression) that the SCS is only for him (the Dr) to oversee.....when (from what I understand) the Reps are supposed to be available to us to help us oversee the care of the unit and the re-programming.....

    Of course, if an issue arises in which the unit placement begins to cause pain or lead migrates, etc, then...the Dr has domain over that, since it is medically related. ?
    I certainly don't claim to know much... :B

    I guess different facilities in different locations and different circumstances make for different outcome... @) Is there any other different way to use the word....'different'.....?
  • I think the whole concept of SCS is supposed to be TEAMWORK. The team is you,your PM and the Rep. Sometimes it seems the PM forgets there is no I in team. They want to be in total charge no matter what. We the patients need to reassure them that our needs need to be met since we have paid for this service. I love my PM. She listens and understands what i need and want. She never tells me whats going to happen, she discusses it with me. This is the way it should be.
  • RRrae said:
    Whose responsibility is it to organize the programming sessions and follow ups? I would assume it is the Dr office right? ok....
    Does anybody have any problems getting ahold of their Rep when they need help or questions answered?

    I have to drive quite a ways to get to my doctor's office, so I always try to schedule meetings with my rep on days when I have appointments with my doctor. Typically, when I'm scheduling my next appointment, the scheduler at my doctor's office will make a quick call to my rep and make sure the date/time fits into his schedule. If not, they work out a date/time that does.

    If I need anything in the interim, I call my rep directly and if I need to meet him at a time when I'm not seeing the doctor, he fits me into his schedule and takes care of making sure there will be an open room at the clinic for us to meet.

    If you don't have any information about your rep or how to contact him/her, all you have to do is call Medtronic patient services directly and they will put you in contact with the rep assigned to your case. Medtronic patient service ---> (800) 510-6735 Hours: 8am-5pm CT

  • rplatt56 said:
    I think the whole concept of SCS is supposed to be TEAMWORK. The team is you,your PM and the Rep. Sometimes it seems the PM forgets there is no I in team. They want to be in total charge no matter what. We the patients need to reassure them that our needs need to be met since we have paid for this service. I love my PM. She listens and understands what i need and want. She never tells me whats going to happen, she discusses it with me. This is the way it should be.
    My doc is on the other end of the spectrum....I always feel as tho I am talking to the back of his head as he is walking out of the room.....He doesn't hardly seem to give a cr@p....as tho he thinks he's so dang good at what he does, that he has the right to 'wash his hands' of me...
    I admit, he is VERY good at implanting these, but he is so arrogant it's ridiculous. I honestly get the vibe that he believes his work is so perfected, that he has no need to spend time in follow up. Grrr!
    Oh well.
    Like I said, I still have yet to call my Rep for a tune up session. I may end up being pleasantly surprised at how wonderful everyone might be about it. :)
  • I wrote the number down.

    I did just get my ID card in the mail today (Re: air port security, etc)

    It's been a month now since my implant and i haven't had a single tweek session yet! But that's on me i guess......been busy and haven't made the initiative to make the call. Now that you've all helped me see clearly how it works, I'll kinda know what I'm doing when I call the Rep. I hope it's the same one that was there during my implant...she was a total sweetheart.

  • I don't really want to mangle this subject since it is a good one. I do need to call the rep listed in my book and see if she is still my rep? (sad story, I believe that the second woman from medtronic who was there day of implant was one of the women killed in the health club shooting in Pittsburgh last year My wife said the name and picture looked like her, I only vaguely recall most of that day.)

    I'm just worn out, frustrated, tired. This is always a busy time at work, for some reason when the sun comes out and everyone else feels better, I hurt worse for a few days, then as soon as I feel better the rain moves in. The few projects I attempt right now have turned to crap. Did have one good day last week. yay

    My PM has nothing to do with me when I go in. He has a PA that thinks he is gods gift to programming. He won't release the pulse width control to me, just the rate and amplitude, I think I have the terms correct. The stimulation I do get is often incomplete. I believe if I had more control I could possibly get it better. From day to day my pain can be all over the place. so sometimes when I see him, well the pain that I need to cover just isn't there!

    I can't help but think if I had that extra little bit of capability I could perhaps find a better result from this thing.

    Oh, and this PM, PA, or is it PIA :D is always in a hurry to get to the next patient, always.
  • I highly recommend contacting your rep or Medtronic directly. There's absolutely no reason why you should have to depend entirely upon your PM and his PA to assist with programming.

  • I agree with C. Call Medtronic. I think its time you may have to consider identifying a new Doctor to manage your care. Your a big boy, it's your body and it's YOUR IMPLANT, demand control. You're the one who has to live with this condition, not the PIA.

    That's my two cents.

  • I just wanted to chime in about my Boston Scientific reps. I have one main rep, and if she is not available because she is in surgeries, etc, then there is another guy I have worked with as well. They are absolutely awesome to deal with!! I actually prefer to work directly with them than through my PM office since my Dr's office isn't that organized. Any time that I have needed them they have pretty much responded back to me the same day. We either meet at my Dr's office if I am close to home or if I am at work they can meet me at a hospital or facility close to my office. They have made me feel very comfortable about calling them with ANY questions or concerns. I have had some issues with my battery that they have been very patient in dealing with. There have been several times after I have had questions that they have followed up after the fact to see how I am doing. It is one of the most amazing customer service experiences that I have had!

    Don't be afraid to contact them with anything. That is what they are there for.
  • I appreciate that input! I'm glad you have such good communication with your Reps! I hope that's how it will be when I start calling mine.

    So, when they come to meet you at the Dr's office, the doctor doesn't need to be there..correct?

    My Docs office sounds kinda like yours....very busy and 'unorganized'....I think it's because they are shorthanded with the front-desk people.....so that's why the communication just isn't there.

    Thanks again!
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