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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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Because it is a denied service, even if you win, insurance companies will only pay what they want and you owe the difference. it's not like you can go in for the service and only owe a co-pay. At least that's the excuse that's been given at both the ketamine providers I've been to, because I was approved by United healthcare before I won my case in WC Court. United only covers about $450-$500 of each infusion, the docs want $1700-$2000.
it's awesome that the inpatient was covered for your daughter and that Dr. S has kept his pricing so reasonable. you are truly blessed....in New England there is no where like that of which I am aware. my first 22 infusions were done in NJ, because when I started there wasn't even a doc up here accepting new patients because of insurance (The Beth Israel in Boston shut their doors to new patients years ago).
I sincerely hope your daughter continues to do well! XOXO. Sandy