Originally Posted by SandyRI

I received a letter from United Healthcare that states that they have approved the physician services for my requested treatments -- when I called and asked about the infusion services they stated that they were also included in the approval!!

I have asked that a revised approval letter be sent to my doctor and to me that specifically states that ALL the services that were requested in the pre-authorization are covered. the adjuster promised that it would be in the mail today.

Because the ketamine infusions are not available "in network," I have already requested and been approved for the consideration of the infusions as in network. So I am only liable for my deductible, not 80%, which is what is charged when you go out of network on my plan.

I just hope and pray that the insurance company plays fair when it is time to reimburse us. My parents are going to pay in advance for me, saving me and my husband from having to liquidate a chunk of our retirement account or run up a home equity loan on our house when we still have 2 kids to educate.

The approval letter states that my appeal was reviewed by a physician that was not involved in the original determination. I have to admit that, IMHO, I think that my appeal letter could have been stronger. Getson's office suggested that, while ketamine may be deemed experimental, I state that ketamine is an ACCEPTED treatment for RSD/CRPS (Diag codes 337.21 and 337.22). In addition, I referred to the recent successful double blind studies by Dr. S and The Netherlands. I also mentioned that United Healthcare has a history of providing coverage for other Rhode Islanders with RSD that are receiving ketamine infusions (after all - if they can pay for THEM, why were they turning ME down???).

Thanks to all of you that gave me advice on my UHC thread - it was really helpful!! And to Kathy and anyone else that is fighting for approval - KEEP FIGHTING! Try the "ACCEPTED" terminology that Getson gave me above, and try to find out if there are any other recipients of the coverage already in your group. Perhaps that will help you.

XOXOX Sandy