Quote:
Originally Posted by keep smilin
Oh let me tell ya..shy little me...
5 people on the committee.. An MVP ins. board of directors - a woman, a Pediatrician, family practice Dr... on and on.. they were quiet... they had reviewed my records before calling me... I am happy with everything I said.. I got it all in..history..interventions tried.. what devastation and debilitating and spreading illness this is...saying RSD cost me my wonderful job of 25yrs, pointed out their recommendation in Burlington was exactly the practice I see here and they do NOT administer Ketamine..I explained the rarity of this but it affects young and old..I explained the money MVP will entail for my RSD health treatment otherwise not having the ketamine, would be more money over time than if they approved my treatment....I pointed out the I paid for the Drexel trip out of my pocket..even saying if I had cancer although that illness is life altering also..they would be very happy to approve chemo or other treatment it would take for extending my life..this is equally devastating. I thanked them for their time, asked if I can answer any of their questions or concerns...I was professional and appreciative. They will get back to me within 5 days with their decision..
I am fighting for us all to receive what we all deserve for treatment... let me at em!!!!!!!
I will keep you all posted!!
Hugz, Kathy  |
Kathy,
I am sorry, but sadly not surprised to hear of your troubles. I know that coverage for Ketamine infusions varies by insurer and by state. Coverage can also vary, for example, if your specific provider is in network or out-of-network. Even one part of the procedure (i.e. the physician's expense) can be in network and covered for a Ketamine infusion, but another part of the procedure (i.e. the surgery center expense) can be out-of-network and not covered, depending upon your specific doctor's contract.
I had a Ketamine infusion last year, so I became very familiar with the reimbursement specifics.
Question #1: Who is your insurer?
Question #2: Does your insurer cover Ketamine infusions in all or in part in any state? If the answer is "No", your chance on appeal is low because they will not want to set a precedent for the rest of us. The pre-surgery benefits coordinator in your physician's office can get the answer to this question for you.
Question #3: If your insurer covers Ketamine infusions in another state, is there anything in your plan to preclude you from going to another state where benefits are covered to seek treatment? If not - BINGO - go to that state and have a physician there do the infusion. I think from reading the RSD Association Newsletter that there was a discussion about states where certain insurers covered infusions. I know that if you posted your insurer on this site, there are others who have had infusions covered in all or in part in other states and could point you to physicians in those states.
Reimbursement for Ketamine infusions can be accomplished with creativity. My insurers did not reimburse any portion of mine, but I know that many of our peers have had theirs covered routinely.
Good luck to you, Kathy!
P.S. If you do find a physician with reimbursement, make sure that he is using the protocol per the most recent article published in the RSD Association Newsletter. It is considered the gold standard for infusions and not all physicians performing them are using it. Infusions are a high profit center for M.D.'s, so ask lots of questions and be informed.