my insurance co. has replied about my appeal!!
 

Sadly.. it is once again ...another denial... They are not approving me for the Ketamine treatment .. grounds being..out of network provider..They ain't budging for ANY part of payment... Thanks for all of your support my dear family..I am going to take some time to digest this news of just a few minutes ago...

Many hugz and thanks again..

Kathy:grouphug:

Do you have an HMO?

So sorry for your news.You will be in my prayers. Fondly-Carol

So sorry, I am sure that this is devastating news, any denial of treatment is. Keep trying, and you have my prayers. Lisa

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:grouphug:

Dear Keep Smilin'
The news of denial are devastating words to hear..

You are always giving everyone hope and encouragement and optimism..
I know you need time to digest this recent judgement..I hope you allow yourself some time to get angry, sad and angry...'cause,friend I am seething..

The Hippocratic Oath that doctors pledge as they begin their practice has these words for the people they will treat and protect...

..."I will keep them from harm and injustice..."

When will these words spill over to the insurance companies who are obstacles to the healing process..

Kathy, keep goin' after that justice!!
love from Hope4thebest :hug:

Dear h4tb..

Well said..!!! I want to re-fill my tank and go after em again..Heck..golly gee...

I do appreciate your very kind words and support...

Love, Kathy:hug:

KS,

To me it would seem that means they have to find an in network provider. Do they have a policy on coverage for when there is no appropriate in network provider ? If they don't have a policy specifically excluding ketamine treatments, I think that is an arguable point.

I know that you must be discouraged now, but sometimes it pays to be the squeeky wheel. If you give up and quietly fade away, they save cash. Wou;d one of your in network docs order the treatment ? I'd try pressure on the insurance company that they need to produce a doc who can perform the ordered treatment. Most insurance companies have provisions for out of network care in certain situations. Try demanding to know what those situations are !

I was so bummed to see your header that you had news with that little thumbs down sign. Boo !

Dear KS, my friend and buddy;

Relax tape a few deeps breaths. I am very proud of you for fighting this, you have lost the battle but not the war. Allow yourself to feel what you feel, then get down sista!!! I do know where one door shuts......we stand there and bang on it, we get angry, cry, pry, and then we find ourselves on the floor crying and looking down the corridor to the door that is open! Your friend Finz has given you some very good suggestions to sneak in through another avenue! Follow your gut, it is in our weakness that we find strength. Man can tear you to shreads, but God knows what you need. Trust in that, and know that our prayers are with you. I truly beleive they have not heard the last of you, just the fact that they did take the time to ponder over this means they are curious. When your nurse friend calls, have your husband talk to her and tell her you have been locked in your room for days and that he is very concerned! I am feeling better tonight, sit back and enjoy the ride, we have come to a fork in the water and I am going to take the other one. Hang in there girl, you deserve this, beleive it.

A big hug from your little buddy:hug:

Jeanie

Good morning.. Jeanie...everyone...


I can't thank you all enough for your support, great thoughts and sweet words... Ya..they have only met me..I have a feeling that this ins. company may well as set me up an application for employment cuz that will symbolize the amt. of time they are going to be spending with me... Although, the NYS dept. of insurance tossed their gloves in yesterday in support of the denial also...
Jeanie..reading your post warmed my heart in the few statements as "Man can tear you to shreads but God knows what you need...and the idea of me being locked in my room..OMG that was sweet and not a bad thought at all..!!!! Sure we shouldn't coast just a bit longer???

Finz..you give me some cool avenues to take and I will need be!!!

Have faith .. this will work out the way it is mean't to be..and if I am not allowed the coverage when it is all said and done it won't be due to my lack of not fighting for it!!

My gloves are back on....

Happy Friday everyone... hugz,

Kathy:grouphug::grouphug:

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.

Thank you, Dubious...
Very imformative, well written note..Yes...I have heard both reasons from my MVP ins. company as an arguement NOT to cover me..the final "put it bed" point was out of network services.. I even called to scream at them and the same..can't do it answer as ..dear friend of mine who is in HR of my co. looked up my policy claiming they are acting accordingly, sadly..My next attempt was then for them to tell me who in my network will perform this procedure...and they came up empty...so in my mind.. I am forced to act out of network then ..

They want to wear us don't and they are!!

Hugz, Kathy:grouphug:

don't ever ever give up
 

I am so so sorry!!

Dont ever give up. Keep on fighting.

Ketamine is an accepted treatment for RSD. More and more insurance companies are paying for it. It is a battle.

You are in my prayers. Please take care.

Much love and peace, Sandy

Sandy..Thank you for your thougths...You are such a positive influence...I am blessed to have so many supporters..I know it will all work out ok..in the mean time..I thank you from the bottom of my heart....My Dear Dad always said..if it comes easy then you ain't doing it right..he knew stuff!!

Hugz, Kathy:grouphug:

keep smilin, Check out this info. I hope it can help you in some way.
http://rsdhealthcare.org/fraudulent-...l#Underpayment