Originally Posted by SandyRI

I filed pre-determination papers with United Healthcare (I have a PPO Plan) for my upcoming 10 day outpatient ketamine infusions, with multiple day boosters afterwards (maybe 12 boosters just in the first couple of months).

United Healthcare sent me a denial letter, stating that "The Plan excludes coverage for therapies considered unproven, and the Ketamine is not covered." I immediately filed an appeal, stating that ketamine infusions are a recognized treatment for CRPS. I wanted to get the appeal on record as quickly as possible, so I faxed a quick letter the day after I spoke on the phone with one of their reps - before I even received a written documentation of the denial in the mail.

Based on discussions that I have seen here and elsewhere, it seems that there are many individuals that have managed to get United Healthcare to cover some of their outpatient ketamine infusions. How exactly did you go about it? Did it require enormous amounts of paperwork and long letters with lots of references to scientific literature? Or a phone call from your treating physician? How long did it take? Were you denied more than once?

Thanks for any advice and help you can provide. The cost for my treatments will approximate $30-$35K. My doctor requires cash, the only insurance he accepts is WC (which has also denied my treatments so far). So United Healthcare's funds would be a reimbursement to us for monies outlaid for my care (by my parents).

XOXOX Sandy