Authorization for Inpatient Ketamine Infusion
 

Hi everyone,

I have questions regarding getting pre-auth from the insurance companies for inpatient Ketamine Infusions. The two pain clinics that I am working with have deemed this as the necessary step. Today when I spoke with the nurses' station they indicated that this is a very long process & has a high rate of not being approved for patients. This terrifies me as my CRPS is getting worse and I am worried about losing the ability to work, care for myself and have any sort of life outside of pain.

What is everyone's experience with this? The protocol at the facility I will be going to is a 4-5 day inpatient infusion...which of course is very costly.

Does it typically take months? Will the insurance insist I do a SCS first?(I am completely unwilling to do this) Thanks in advance for any insight!

Hi Inspire,
I wish I could be of some help to you but I never had that. So in the words of Sgt. Schultz "I know nothing"!
I just wanted to wish you luck...

Hi,

The costs of SCS are quite high and with the potential for complications I can't imagine they would insist on that first. They can't dictate that you try an invasive treatment.

I don't know anything about getting pre-auth for inpatient infusions or how long it would take. Often there does seem to be some skill involved on the part of pre-auth people. I too am concerned about where that leaves you in the interim.

Did they say the reason for going straight to inpatient? Though I get a low dose outpatient, CDwall is getting something really high like 500mg as an outpatient over 4 hours or so. Inpatient may very well be the best protocol for you. I just hope you don't have to wait to long...

You might try calling your insurance company to see if they can offer any history of how they have handled this in the past.

Hang in there and let us know what happens.
Sending hugs and healing love, :hug:

It all depends on your insurance company. I have been getting outpatient ketamine infusions for over a year now(covered by my insurance), which have helped TREMENDOUSLY. Last year I had wanted to go for a 5 day inpatient infusion at a place in Arizona, but my insurance companied denied it. I appealed their decision and it was taken to an independent arbitrator with the state's insurance board who agreed w/ the insurance company. Then I had to have several surgeries (gall bladder removed and duodejunostomy for Superior Mesoteric Artery Syndrome). Finally, when I was healed and well enough to travel, I found another doctor who performs a 7 day inpatient infusion in the ICU of a major hospital. When they sent a pre-auth to my insurance company it was approved immediately. I was pleasantly surprised.

I hope you have good luck!

I had an outpatient ketamine infusion about 2 years ago, and It worked! For two weeks...BUT it was the best 2 weeks of my life in over 8 years. after the 2 weeks we started the 3 to 4 hour booster and I only got two days of relief. Again we tried the booster the next month and it seemed to be just a couple of hours.I did not like the booster, as I had a "bad trip" so to speak. It was very scary. The week long infusion at home was great, but I needed a babysitter for me AND my kids for a week. It was hard on my husband, my kids, and my family/friends that stayed with me.I am ready to ask for another outpatient ketamine infusion, but I dont think they do them anymore. How long have the inpatient ketamine infusions been going on? Its not the coma infusion, is it?

The 7 day infusion in ICU is NOT a coma infusion, those are illegal in the US. They start you at a low dose 60-100mg/hour (depending on weight and tolerance to ketamine) and bump you up each hour until you get the "ketamine eyes" (where they dart back and forth). They give you enough Versed so you do not hallucinate and are still somewhat lucid during this time. (You can eat on your own). On the 6th day, they do a total block of the limb (for me it's my left leg) to where you cannot feel it at ALL. This shuts down the brain from communicating w/ the affected limb and helps to reset it. They have a family member or friend stay with you the entire time (so you don't freak out and not recognize anyone when you are "out of it"). If you need a booster, the doctor will not do one until 3 months after the hospitalization. If the booster does not work, then he will re-hospitalize you for another go round. From what I have been told, this rarely happens and most people go into remission from the first treatment. But, it all depends on how long you have had the disease and other health factors. (as with anything else and any other treatment).

I hope this helps.

Wow, thanks. I have not been paying attention lately. Just raising my kids and living on pain meds and a SCS. This is the first I have heard of in patient ketamine. So, since I am spreading, and I had a good result with the 5 day ketamine infusion at home, I may need to jump on this. I will call the PM tomorrow!
Thanks

I have no idea about insurance, but I have CRPS for 10 years, we tried everything, then went to a SCS. The SCS worked by about 50% helpful but not full relief. i use it on long trips, parties, my kids functions. It has given me back part of my life, which is better than none. It helps with my arm and shoulder, but not my face and lips and Im gonna check with my insurance on the inpatient ketamine infusion. I will let you know what I find out