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Member
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Join Date: Jan 2009
Location: Paradise
Posts: 855
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Member
Join Date: Jan 2009
Location: Paradise
Posts: 855
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Quote:
Originally Posted by keep smilin
Thanks everyone... Yes, Jimking..I have an HMO..it's called MVP.. I am just befuddled on how in the world we live in..others who have not the faintest idea nor do they care can make decisions about someone elses well being without even a glimpse or concern...I personallycouldn'tdo it..I'd be broke cuz I would be paying for others health care needs mostly cuz it would crush me to turn my back on someone in need...
Hugz and sleep well my family... Don't worry..I guess I was not mean't to have my Ketamine treatment...
Kathy  |
Hi Kathy, It's definately an uphill battle. Usually, an HMO will pay for treatment that is available within their IPA. So I doubt there is a doc who is experienced with ketamine therapy in your group. Now, if a certain therapy is not available within your IPA, then you can argue with the insurance carrier that it is an absolute medical certainty that you need this therapy and demand a referal outside the IPA which they would be on the hook for. The IPA, HMO and your state will all have appeals processes to employ for this. My guess is that where they unfortunately will trump you will likely be their determination that ketamine is an "investigational" procedure for which is just a flat-out exclusion on the policy, ending all approaches. It would then be incumbant upon you to "prove" that ketamine was an accepted standardized type of treatment and it would also help if you had some professional papers, peer-reviewed studies with controls, to bolster your position. It's a stretch, but it can be done! You could also speak with an attorney but you would need to show further damages from you not getting the ketamine as the Knox-Keene Act goes a long way to protect them.
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