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Originally Posted by betsykk
The FDA has approved ketamine for breakthrough pain. It is getting more and more difficult for insurance companies to deny this. If you are turned down I would most definitely follow up with your appealS. yes, appeals, plural. You get more than one. This is one fight worth fighting.
I would also suggest buying Barby Ingle's books which deal with ketamine and all the factors involved with it. She is a wealth of information and I know we would not have come as far without her guidance.
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It's difficult but they do. I just paid $2500 out of pocket for my 5 day out patient treatment as the rate has gone up to $500 per day. For my in patient treatment, my insurance (Aetna) fully covered my hospital stay and everything done in there but would not cover the Dr's fee since he was adminstering ketamine tho I need to look into this further and perhaps fight it.
Their policy is that if it's being done continuisly through IV and inpatient, they will cover it but will not cover it out patient or for intermittent use as they still feel it is experimental for RSD.
While they quoted numerous Dr's research showing positive results, their issue supposedly with it is that they do not know the long term effects of regular ketamine use on people with RSD.
My Dr said the other day that worse case, it's another 5-10 yrs before they approve, easy for him to say. I have 3 teenagers to get through college and my health bills are eating through all I have yet it's saving my life.