outpatient ketamine infusions
 

I went up to Cleveland Clinic the other day. My doctor there really wants me to try ketamine infusions, once a week for several weeks. I do not think my insurance will cover it. Even if they do, they won't cover doctors fee, or the fee for the outpatient room, and what they will cover will only be 70%. And, I still have nearly $3000 to meet on my deductible.

I have not worked since December, filed for disability in May. When I filed, I went in to the office to do it, and the woman there who helped me file, back dated my filing to well before I stopped working, as my employer had to make a lot of adjustments the last year I was working due to my RSD. I did not quite understand what she was doing, but it sounded like my date of onset of disability would preceed my date of stopping work... which would mean my date of being eligible for medicare would be sooner.

Now I am still on Cobra.

I am wondering if anyone has had Social Security Medicare cover ketamine as outpatient.

I am thinking I will wait to see if I get disability first time (yeah right, I know, chances are slim)... I should hear something end of Oct. or in Nov. Then, if I do, wait to get Medicare before getting ketamine. I've had RSD almost 10 years, what is a few more months wait.

Otherwise, this is going to cost me a lot of money I just do not have.

I know that there were people at Getson's clinic that were getting outpatient ketamine that were on SSDI and Medicare. So it appears he was likey accepting Medicare for payment for the infusions.

I would stay on top of your inquiries - follow up on everything to ensure that what the hospital is telling you is accurate. And ask how quickly the bill needs to be paid. Maybe you can pay them $10 a mth for a really, really long time (like forever...). Obtain the list of ketamine docs from Jim Broatch, perhaps there is another doc that you could see that will accept your coverage.

Never, ever give up. I am so sorry that you have been sick for 10 years. Ughhh.... XOXOX Sandy

Ketamine @ Cleveland Clinic
 

HELLO RSD sufferer;
I am going to have the 5 day out-patient ketamine for the second time at Cleveland Clinic Pain Clinic. I had Medicare when I had it last year,and combined with my Blue Cross it covered it well. Hope this helps.

Barb117

I started my out patient ketamine with getson and his price for the treatment was 1,100 per infusion at that time and it was 4 years ago. I had blue cross and it paid it for me. When I joined him in 08 for the treatments he wasn't taking medicare or Medicaid from new patients to pay for treatments. He had a former practice before moving to the new location and he allowed his old patients to continue with medicare and Medicaid. I was told if I wanted them to pay for them that I would have to summit whatever the other insurance wouldn't pay. I have been with a new doctor since 2010 so don't know what Getsons doing with paying anymore. But with me both my medicare and Medicaid wouldn't pay for infusions or for the home medication my blue cross which is now atnea has paid for it the past 7 years I have been on it. If others have been able to get medicare or Medicaid to pay for it that's great.

Hi,

I would love to hear about your Ketamine infusions, the side effects and how it's helped you if you wouldn't mind sharing.

Thanks so much.

I hope it works out! I'd love to hear. I don't want opioids and constipation....and since this is an antagonist...no constipation. HOWEVER if you need surgery or have an acute pain episode (as opposed to chronic) you will NOT be able to take opioids for the acute pain/ surgery or otherwise. That is a drawback. CCF plants a pain pump for these situations...but I don't live in Cleveland so my emergency will not get me that pump. Only one doctor in Columbus does this and I don't care for him...he doesn't even fill them...has someone else do that. ??? Anyway........there are drawbacks.

Was lucky enough to discover a new Pain Management Dr. who spent last 7 years as the Director of ALL Pain Treatment at the Walter Reed / Bethesda Military hospitals as a Navy Commander - so you KNOW this guy has seen EVERY type of injury and treated thousands of troops with medical matters similar to mine (I was blown up by an IED in Iraq which left me with TBI, PTSD, and severe Cervical Spine damage!) I realize you may not be from military but this is what I learned.

He stated that they have been treating every troop who comes there from overseas with Ketamine RIGHT AWAY and it has shown to reduce pain levels, PTSD, anxiety and other symptoms big time - so they put them on it immediately to prevent these from acting up. Now fast forward - he retired from Navy and has started his own practice here in the Metro Washington DC / Virginia area and has been treating me for last 4 months. Matter of fact he just did a cervical RFA on me yesterday so hence Im sitting here in pain at home surfing this forum. Next month we are going to start the Ketamine Infusion with the first session being only 1 hour, then next treatment is a 1 day, then next s Mon, Wed, Fri. and lastly (if needed) a full 5 day Ketamine induced coma in the hospital under his direct observation!

What sucks is that I can't be treated at Walter Reed side Im Retired, VA just started doing acupuncture a few years ago so they are OUT and SUCK, and civilian insurance companies have really yet to catch onto this treatment yet - however he will articulate all success in detail and submit to BCBS for review. Its $900 a day and the 5 day coma is 5k which is ALOT but if it relieves my pain, gets me off opiates, and helps with PTSD the money is a drop in the bucket folks! Looking forward to this very much and will surely let you all know how things go if anyone wishes me to?

Best of luck to you all out there friends!

Gunny

Just a little note on SSDI and Medicare. I was fortunate to be approved for SSDI the first time I applied (in 2014) for my CRPS. I, too, am on COBRA. However, you cannot apply for Medicare until about 2 years AFTER you have been on SSDI unless you have a life threatening disease (i.e. ASL or need a kidney transplant). I had an attorney file my SSDI claim (which I would highly recommend) and I was reimbursed his "fee" through my LTD carrier. My attorney even said you have to be "dying" to get Medicare right away and even though my CRPS is very severe (has spread to internal organs now), I would not qualify.

I wish you the best. I hope you are able to receive the ketamine infusions because they really do help. I get them every other week until I am able to go for the 7 day inpatient infusion. My insurance does cover the majority of the payments. A resource you may want to check out for help with payment is the Power of Pain foundation. They gave me some information on help with paying for ketamine infusions.

Good luck and God bless

Just to clarify, there is a two year wait period from the time of entitlement for SSDI recipients to receive Medicare. When you factor in that you can receive 12 months retroactive benefits from the application date and waiting time for approval, the two year wait period often isn't even an issue. Those that qualify for SSI have no wait period.

Anyone that has a Work Comp injury really should make sure SS signs off on any medical set aside before formalizing a settlement even if they have no current intention of applying for SSDI. As we all know, CRPS can spread or plain just get worse.

And anyone living in CA, HI, NJ, NY and RI please be aware that if you become unable to continue working due to your CRPS, your state has a temporary disability program which is much easier to qualify for than SSDI. MD has a temporary disability assistance program that offers cash, medical and housing assistance.

What hospital in VA are you getting the infusion? I've been trying to find a dr in or close to va that would let me try ketamine for chronic pain. Any info you'd be willing to share, is greatly appreciate!!