Dear Sandy,
I am sorry that it has cost you so much for your daughter out of pocket - WOW!! And still she suffers. I am so sorry! Was the Cleveland Clinic program similar to what is offered by CHOP (Children's Hosp of Phila) and Boston Children's Hospital in Waltham, Ma? I've read that the intensive PT programs often are extremely successful with teenagers - see the RSDSA.org website for lots of info on the subject.
I also have United Health, which is my back-up insurance to Work Comp. Neither is very good. I am 49 but, just like your Lindsay, MY parents are going to pay for my ketamine treatments with Dr. Getson. My husband and I don't have the resources right now for that because I've been out of work for so long. And, unfortunately, Getson's lack of strong qualifications are going to hurt my petition in the RI WC courts - the judge is not likely going to order the insurance company to pay for him because of that. He has so much experience, though, I am still comfortable going to him and I just need to get better and go back to work.
I have submitted a request to United Health for the ketamine - and I am hoping that they will reimburse my parents something when this is all over. I have a max deductible on my plan that's not too, too awful... and I have managed to get this treatment ruled as "in network" because it's not available in our network at all. Have you tried that yet??? It makes a difference with the deductible!! I had to talk to a different department at United to get the ruling, and it took about a week or so.
Good luck with your daughter -- I pray for you guys -- XOXOX Sandy
Quote:
Originally Posted by SandyS
Hi Everyone,
Not to have you go to any other forum, but there is a facebook forum that is RSD called Ketamine Klub for RSD/CRPS patients. I believe there are a lot of discussions about insurance companies not paying. I know that when I took my daughter for the infusions with Dr. K, I paid the $500 initial appointment, plus the infusions, and then again for the infusions. When I phoned the insurance company they gave me the run around about him being out of network and how they probably would pay MAYBE $2,000 from each infusion... So to sum it up, out of $16,000.00 They MAY pay $4,000.00 but it would be put toward the out of network deductible. Nice huh???? I think with the insurance companies, Ketamine hasn't been around long enough.
Now as far as Dr. S is concerned. If he accepts that insurance there shouldn't be a problem.
When my 16 year old daughter was accepted into the pain program at the Cleveland Clinic Childrens hospital, my insurance denied it as well. Her primary care doctor got on the phone and called the insurance company and told them that this was the ONLY thing that could be done at this time, we had exhausted every thing else. It only took the call from her doctor saying it was medically necessary for this treatment. Then five months later they never hesitated to admit her again for another course of treatment in the Same Pain program, Imagine that???? I don't know what insurance you have but we have United Health Care and on most of the boards they are the insurance company that is so difficult to deal with.
BE you own voice, get on the phone and don't quit, Don't give up. If you can somehow afford that initial appointment go and see what he has to say. Then submit it to the insurance company and go from there. Don't give up your appointment. You can always fight the insurance company after Dr. S. say's you need treatment. Like everyone said he is a well know doctor at Drexel. let him argue once you have that appointment. I am sure he will fight for you. So GO GIRL...BE STRONG. Let us know what happens.
I am praying that you are accepted. Keep your chin up.
 Sandy |