[keep smilin]

Hi everyone..I just have to write before I cry and say...I just got word that my ins. carrier just called..not approving my Drexel appt... under the conditions that it is experimental.. Maybe this is my B but..isn't it only considered experimental in other countries..not ours?? The long coma... but short infusions and outpatient here covered..did some here get it approved before?? This may be my misunderstanding and if it is..I apologize...Not that I felt confident but my insurance is wonderful with life time benefits and no max...I thought I had a chance.. I will speak with my Dr. to inform them of the decision on Monday and the ins. woman encouraged me to put in an appeal..asap..as my appt. is in only 3 weeks away.... OMG..my pain is killin me...

it's okay.. really I am fine...I won't let this get me down..I still have a great life..

Luv, Kathy

[SandyRI]

are you telling us that your initial consultation is not covered? Or that ALL consultations with Dr. S. have been denied by your insurance carrier?

Dr. S. is a board certified neurologist, with at least 30 years experience, and is currently the Head of Neurology at Drexel (Hahneman Hospital) and you have RSD/CRPS . He is extremely qualified to treat you - probably one of the MOST qualified in the US.

BUT I was told on the phone by Dr. S.'s admin asst. when I booked my initial appt that it would cost $500 and that it would NOT be covered by insurance. My initial appt. with Getson was $400 and it was NOT covered by insurance either. Getson is NOT board certified in much - his qualifications are not nearly are impressive as Dr. S's, (and, as a matter a fact, due to the absence of Getson's strong board certifications, it is proving very difficult for me to argue in a WC courtroom that I need him as a treating physician for ketamine to get me better!!).

I would appeal the decision of your insurance carrier immediately. Ask them for rapid resolution. Tell them its an emergency. Keep talking to someone until you get the answer you want. Don't give up.

You are going for an evaluation, not an experimental treatment. He hasn't even provided you with a treatment plan yet. How can they deem that experimental?

Good luck and don't ever ever ever give up. XOXOX Sandy

[keep smilin]

Originally Posted by SandyRI

are you telling us that your initial consultation is not covered? Or that ALL consultations with Dr. S. have been denied by your insurance carrier?

Dr. S. is a board certified neurologist, with at least 30 years experience, and is currently the Head of Neurology at Drexel (Hahneman Hospital) and you have RSD/CRPS . He is extremely qualified to treat you - probably one of the MOST qualified in the US.

BUT I was told on the phone by Dr. S.'s admin asst. when I booked my initial appt that it would cost $500 and that it would NOT be covered by insurance. My initial appt. with Getson was $400 and it was NOT covered by insurance either. Getson is NOT board certified in much - his qualifications are not nearly are impressive as Dr. S's, (and, as a matter a fact, due to the absence of Getson's strong board certifications, it is proving very difficult for me to argue in a WC courtroom that I need him as a treating physician for ketamine to get me better!!).

I would appeal the decision of your insurance carrier immediately. Ask them for rapid resolution. Tell them its an emergency. Keep talking to someone until you get the answer you want. Don't give up.

You are going for an evaluation, not an experimental treatment. He hasn't even provided you with a treatment plan yet. How can they deem that experimental?

Good luck and don't ever ever ever give up. XOXOX Sandy

Yes.. exactly..they have denied me all coverage..initial consult in all...they even understand that this is a "rush" visit as my Dr. stated it is..they moved my appt. up twice due to the aggressiveness of my RSD.. but still notta... You are right.. I won't give up..I will beging the appeal first thing Monday morning..the woman on the phone strongly urged me to do just that... AND after reading your post, Sandy.. I promise I won't go down without a fight!! I promise...


Thank you for your thoughts..

Kathy xo

[RNcrps2]

I was also told that it was 500. and not covered by insurance. Dr. K in Fla. is also 500. and doesnt except insurance- you can fill out an insurance form yourself and submit the receipt. It is strange that insurance wont pay for any of these neurologist consults. I mean if i need to go to a specialist and i have a referral why arent they paying???? I can understand ketamine but not the initial consult of a specialist. They payed for my pain Drs. consult. hum.

[kathy d]

Hi Kathy,
I am bummed out too. I am fighting the ins co too and know that they do not want to pay for anything especially now with the economy the way it is. Unfortunately, we suffer. I don't want you to give up. FIGHT THEM. File an appeal asap and call your local congressman asap. Get the congressman to shake them up a bit. Also, you might want to contact the news in your area so they can put it on tv and say the ins co name. You will see how fast doodoo flies. haha. Hang in there and get your guns out so to speak. I have been fighting to get my ketamine for 3 years now and have a court date this wed. The fun never stops. Hang in there.
kathy d

[loretta]

Originally Posted by keep smilin

Hi everyone..I just have to write before I cry and say...I just got word that my ins. carrier just called..not approving my Drexel appt... under the conditions that it is experimental.. Maybe this is my B but..isn't it only considered experimental in other countries..not ours?? The long coma... but short infusions and outpatient here covered..did some here get it approved before?? This may be my misunderstanding and if it is..I apologize...Not that I felt confident but my insurance is wonderful with life time benefits and no max...I thought I had a chance.. I will speak with my Dr. to inform them of the decision on Monday and the ins. woman encouraged me to put in an appeal..asap..as my appt. is in only 3 weeks away.... OMG..my pain is killin me...

it's okay.. really I am fine...I won't let this get me down..I still have a great life..

Luv, Kathy

Hi Kathy, I am very sorry. I know it is so frustrating. I wonder if there is someway you could get names and insurance companies that have approved treatment for RSD. Could you post a question, ones that respons may even know others that have been thru the treatment. Of course the hospital or Dr. can't give you information unless you call them and ask if anyone has given permission to give their name out and willing to discuss their treatment.
Some patients give their name for this purpose. I agree to appeal this as soon as possible.
Please let us know how it goes. Hoping the best for you-loretta with big soft hubs

[bobber]

Hi KS
Im so sorry to hear about the cancellation,,,beings that you have good insurance,,,appeal it,,pray to God on it,and do your part and swing for the fence's,,,,,,,,I dont know much about the ketamine,,,,I thought you were going to try to get the infusions?? or oral ?? if its oral,,cant you just get another dr to dx this?/ Im just brainstorming,,theres always a way,,best wishes to you,,Me and darlene will lift you up in prayer tonite,,,,,,bobber,,,,,,We pray that the Lord will heal you so you dont have to worry about making the trip to drexel,,,,,The Lord is the perfect physcian anyway,,,

[SandyS]

Hi Everyone,

Not to have you go to any other forum, but there is a facebook forum that is RSD called Ketamine Klub for RSD/CRPS patients. I believe there are a lot of discussions about insurance companies not paying. I know that when I took my daughter for the infusions with Dr. K, I paid the $500 initial appointment, plus the infusions, and then again for the infusions. When I phoned the insurance company they gave me the run around about him being out of network and how they probably would pay MAYBE $2,000 from each infusion... So to sum it up, out of $16,000.00 They MAY pay $4,000.00 but it would be put toward the out of network deductible. Nice huh???? I think with the insurance companies, Ketamine hasn't been around long enough.

Now as far as Dr. S is concerned. If he accepts that insurance there shouldn't be a problem.

When my 16 year old daughter was accepted into the pain program at the Cleveland Clinic Childrens hospital, my insurance denied it as well. Her primary care doctor got on the phone and called the insurance company and told them that this was the ONLY thing that could be done at this time, we had exhausted every thing else. It only took the call from her doctor saying it was medically necessary for this treatment. Then five months later they never hesitated to admit her again for another course of treatment in the Same Pain program, Imagine that???? I don't know what insurance you have but we have United Health Care and on most of the boards they are the insurance company that is so difficult to deal with.

BE you own voice, get on the phone and don't quit, Don't give up. If you can somehow afford that initial appointment go and see what he has to say. Then submit it to the insurance company and go from there. Don't give up your appointment. You can always fight the insurance company after Dr. S. say's you need treatment. Like everyone said he is a well know doctor at Drexel. let him argue once you have that appointment. I am sure he will fight for you. So GO GIRL...BE STRONG. Let us know what happens.

I am praying that you are accepted. Keep your chin up.

Sandy

[SandyRI]

Dear Sandy,

I am sorry that it has cost you so much for your daughter out of pocket - WOW!! And still she suffers. I am so sorry! Was the Cleveland Clinic program similar to what is offered by CHOP (Children's Hosp of Phila) and Boston Children's Hospital in Waltham, Ma? I've read that the intensive PT programs often are extremely successful with teenagers - see the RSDSA.org website for lots of info on the subject.

I also have United Health, which is my back-up insurance to Work Comp. Neither is very good. I am 49 but, just like your Lindsay, MY parents are going to pay for my ketamine treatments with Dr. Getson. My husband and I don't have the resources right now for that because I've been out of work for so long. And, unfortunately, Getson's lack of strong qualifications are going to hurt my petition in the RI WC courts - the judge is not likely going to order the insurance company to pay for him because of that. He has so much experience, though, I am still comfortable going to him and I just need to get better and go back to work.

I have submitted a request to United Health for the ketamine - and I am hoping that they will reimburse my parents something when this is all over. I have a max deductible on my plan that's not too, too awful... and I have managed to get this treatment ruled as "in network" because it's not available in our network at all. Have you tried that yet??? It makes a difference with the deductible!! I had to talk to a different department at United to get the ruling, and it took about a week or so.

Good luck with your daughter -- I pray for you guys -- XOXOX Sandy

Originally Posted by SandyS

Hi Everyone,

Not to have you go to any other forum, but there is a facebook forum that is RSD called Ketamine Klub for RSD/CRPS patients. I believe there are a lot of discussions about insurance companies not paying. I know that when I took my daughter for the infusions with Dr. K, I paid the $500 initial appointment, plus the infusions, and then again for the infusions. When I phoned the insurance company they gave me the run around about him being out of network and how they probably would pay MAYBE $2,000 from each infusion... So to sum it up, out of $16,000.00 They MAY pay $4,000.00 but it would be put toward the out of network deductible. Nice huh???? I think with the insurance companies, Ketamine hasn't been around long enough.

Now as far as Dr. S is concerned. If he accepts that insurance there shouldn't be a problem.

When my 16 year old daughter was accepted into the pain program at the Cleveland Clinic Childrens hospital, my insurance denied it as well. Her primary care doctor got on the phone and called the insurance company and told them that this was the ONLY thing that could be done at this time, we had exhausted every thing else. It only took the call from her doctor saying it was medically necessary for this treatment. Then five months later they never hesitated to admit her again for another course of treatment in the Same Pain program, Imagine that???? I don't know what insurance you have but we have United Health Care and on most of the boards they are the insurance company that is so difficult to deal with.

BE you own voice, get on the phone and don't quit, Don't give up. If you can somehow afford that initial appointment go and see what he has to say. Then submit it to the insurance company and go from there. Don't give up your appointment. You can always fight the insurance company after Dr. S. say's you need treatment. Like everyone said he is a well know doctor at Drexel. let him argue once you have that appointment. I am sure he will fight for you. So GO GIRL...BE STRONG. Let us know what happens.

I am praying that you are accepted. Keep your chin up.

Sandy

[keep smilin]

Originally Posted by SandyRI

Dear Sandy,

I am sorry that it has cost you so much for your daughter out of pocket - WOW!! And still she suffers. I am so sorry! Was the Cleveland Clinic program similar to what is offered by CHOP (Children's Hosp of Phila) and Boston Children's Hospital in Waltham, Ma? I've read that the intensive PT programs often are extremely successful with teenagers - see the RSDSA.org website for lots of info on the subject.

I also have United Health, which is my back-up insurance to Work Comp. Neither is very good. I am 49 but, just like your Lindsay, MY parents are going to pay for my ketamine treatments with Dr. Getson. My husband and I don't have the resources right now for that because I've been out of work for so long. And, unfortunately, Getson's lack of strong qualifications are going to hurt my petition in the RI WC courts - the judge is not likely going to order the insurance company to pay for him because of that. He has so much experience, though, I am still comfortable going to him and I just need to get better and go back to work.

I have submitted a request to United Health for the ketamine - and I am hoping that they will reimburse my parents something when this is all over. I have a max deductible on my plan that's not too, too awful... and I have managed to get this treatment ruled as "in network" because it's not available in our network at all. Have you tried that yet??? It makes a difference with the deductible!! I had to talk to a different department at United to get the ruling, and it took about a week or so.

Good luck with your daughter -- I pray for you guys -- XOXOX Sandy

I am touched..thank you all for your kind words, for caring and advice on how best to approach this matter..I do feel better than Friday when i got the news @ 4:45pm..and I sat right down and wrote to you all...because I knew you would shed light on my situation..Mostly you all gave me the will to keep moving forward and not cave!! At very least, I will not give up my consult, I will pay the 500.00 for the consult and see what Dr. S has to say and go from there..In the mean time I will explore the appeals and get it moving tomorrow...It just kills me that we are victum to such a devestating illness..which leaves us little hope and our insurance companies could care a less.... Their reasoning was due to the fact it is considered experimental, right Abbe.... And it is out of state..(although she didn't say that was part of their decision but it is out of network)..Kathy d...I want to wish you a world of luck on Wednesday for your hearing and to let you know I won't stop fighting.... for you or me....

To all of you, my friends... You are awesome...bless each of you as without you..I know I would be very sad and lacking the will to fight..but I am going to fight and I feel strong now mostly due to your happy words, encouragement and friendships!!!

I luv ya all!!!! Kathy