NeuroTalk Support Groups - United Healthcare coverage of ketamine infusions

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- Reflex Sympathetic Dystrophy (RSD and CRPS) (https://www.neurotalk.org/reflex-sympathetic-dystrophy-rsd-and-crps-/)

- - United Healthcare coverage of ketamine infusions (https://www.neurotalk.org/reflex-sympathetic-dystrophy-rsd-and-crps-/115838-united-healthcare-coverage-ketamine-infusions.html)

What is so pathetic about this whole thing is that Workman's Comp is actually the liable party. I am fighting with United Health because my WC case is still in the courts.

I put together a spreadsheet demonstrating how it was to WC benefit to pay the funds for the ketamine infusions and get me better and back to work, in lieu of my weekly disability and all the meds. At the end of 6-7 months it would save them about $30,000. I gave the computations to my attorney for him to show the adjuster.

I don't get it....we all know they don't have a heart or a soul. But it seems like they don't have any brains either...

Thanks Mike. I appreciate your input, very interesting. I have a call in to the benefits dept.

XOXOX Sandy

Quote:

Originally Posted by fmichael (Post 628394)

Sandy -

The argument with UHC is that if ketamine "cures" you, which might be read as a normal life with monthly boosters, $35,000 up front with maybe another $6,000/year for boosters is peanuts compared to the "present value" of another 16 years of healthcare spending (including Rx meds) at the rate you've probably been going over the last few years. This argument is particularly effective with the Employee Benefits Dept., if, as is not uncommon practice but unknown to the subscribers, the employer is actually self-insured and using the insurance company simply as its claims agent, such that each month/week the employer writes one check for what the carrier has paid out as a whole, along with an agreed management fee.

And I didn't pull 16 years out of the hat: at age 49, that's when your coverage probably switches over to Medicare. (Although who knows what year of age that might be extended to in the meantime, in what could amount to the ultimate budget balancing trick.)

And for those who want to know, "present value" is defined as the value on a given date of a future payment or series of future payments, discounted to reflect the time value of money and other factors such as investment risk. Check out the Wikipedia article for the formulas, if you want to see them. http://en.wikipedia.org/wiki/Present_value

And for a insurance companies, this stuff is second nature. The easiest example being so-called "structured settlements," where instead of a plaintiff collecting $X as a lump sum, and taking a huge tax hit to the extent that part of it is deemed by the IRS to have been paid for the present value (PV) of what would have been his or her's anticipated income stream to age 67+/-, the parties agree that the carrier will make a stream of annual payments, typically having a PV somewhat less than X (thereby saving the carrier money, assuming it has wisely predicted long-term interest rates) while the plaintiff, in turn, pays taxes at a lower marginal rate on the lost earnings component of the annual payment, such that the PV of the stream of the plaintiff's after tax NET payments is greater than what s/he would have received after taxes in a lump sum. (One of the issues for the plaintiff being in insuring continued payments even if the carrier goes belly up, sometimes done with a letter of credit issued by a "too big to fail" bank). But now I REALLY digress . . .

Mike

Dear SandyRI
Im so sorry to hear about your denial,,but not surprised,,health care and insurance reputations are nonexistant,,I payed for 2 years and fought tooth and nail for them to pay anything,,they keep kicking claims in hopes to beat you down to give up,,this whole world is corrupt,,this whole stinking world,,,the last year of my health insurance,as soon as I surpassed my pre-exsisting clause,put me on another network for which restarted my prexsisting for another year,,I called the commission office and everyone in the administration board,,theres nothing for me to do,,now everyone wont take me because they know of my RSD,,I dont have deep pockets either,,so,Im going to try to get into a health pool,,,Back to your story,,,,its a crying shame that the governorment doesnt step in to give people who despertaly need help,meds,treatments, to function,,I bet that ketamine bag doesnt cost them $2.50 a bag,,,,,,they just got to hype it up and add hidden fees to MILG {making it look good},,,,,,And to make it appear to be a reputable establishment to justify the cost,,,,,,,Yeah,Yeah,,Im not biteing on it,,,we all need treatment,,,I was told that the SCS was a astronominal price for me,,My I-pod {in reality ] is more sophistacated and cost more that a SCS,,,its all about the money,,someone needs to go to bat for us and get the treatment we need and to force the gov to do something,,,By the way,,I traveled to elpaso TX 2day and waited hrs to see a Drt about my condition,,jsut for him to look at me and ask what was RSD,,,this is the 4th Dr in the last year to ask me this,,,,,,,this grieves me,,,,,Good luck to you,,,I hope you get the ketamine,,,,but its track record isnt that good anyway,,,,Theres only 3 ways for me to be able to get proper treatment that will surffice me,,,{1} If I was a famous person {2} if I was a millionaire {3} from the hand of the Almighty,,,,,My money is rideing on the Lord,,Im sick of this place,,Thats why I'll be on my knee"s tonite, asking the one who can and WILL do something about this,,,,,,,,,,I bet if our president or anyone in congress got RSd,,there wouldnt be any problem for treatment,,,,Im too low on the food chain,,,,,,this world SUCKS

YIKES! Sorry you have to suffer this..

Bobber - and everyone else - thanks. I'm sorry for everyone else's struggles too. Life is not fair.

Quote:

Originally Posted by bobber (Post 628982)

Bobber, my wife has had RSD since 2002 and fought the insurance racket for years and also doctors afraid of the DEA and fearing we were drug seekers. We no longer have insurance because of the system was able to rid my wife because of technicalities in the system. However, you can bet your bottom dollar all this will change in couple of months. The healthcare bill will pass. At the very least the pre-existing condition clause will be abolished and discriminatory practices in premium pricing eliminated. This will happen for sure, so hang in there! jim

UHC covered my 5 day inpatient ketamine infusion. I think I paid about $2000.00 out of pocket,,,,

Debbie

Quote:

Originally Posted by Jimking (Post 629049)

Oh, but there will be greater and more severe "technicalities" in the proposed system, to be sure. Pre-existing will "be covered" however evidenced based medicine or best-practices payment will virtually eliminate any meaningful treatment, other than the "blue pill," for costly diagnoses (us).

Imagine having the worst HMO, with little ability to select your doctor, who will not be able to utilize any treatment other than what the "plan" authorizes, who gets paid a higher percentage by delivering less care, and if you don't like it, tough! At least now you can complain, file appeals with your plan and the state and at the end of the day, get something more than you got before. But if it goes to a national/socialized basis, there is NO appeal process. Period.

And at best, it won't be this good....

And we have not even come to the bridge of what happens when the good docs we all go to and love say simply, "we won't take patients with 'government' insurance?" Where do we go then?

No, no, no, not for me...!

Jim - Have you READ Obama's plan? There is a good reason so many want to start over....it truly sucks!! (Sorry to jump into politics here...)

Quote:

Originally Posted by Jimking (Post 629049)

Quote:

Originally Posted by SandyRI (Post 629436)

Jim - Have you READ Obama's plan? There is a good reason so many want to start over....it truly sucks!! (Sorry to jump into politics here...)

I understand everyone's concern but, keep in mind Obama's plan is not UHC. In fact it compells for profit insurance to except pre-conditions. There is no "one payer" in the bill. In reality the bill restructers the US's insurance for profit system not healthcare but I do understand HMOs and how bad they are. I also remember our HMO controlling my wife's doctor so I certainly wouldn't want the government doing this also, but, push comes to shove you can lobby your government for change (hopefully), not so much so with UnitedHeathCare for profit insurance. By the way I'm a slightly right moderate who's withnessed alot these past few years changing my perspective a bit. If it were up to me I'd yank insurance company's Anti-Trust exemption, allow the fed to regulate the health insurance industry instead of each individual state. This, I believe, will compel the health insurance companies to really---really compete.

Quote:

Originally Posted by Jimking (Post 629447)

Jim is 100% right on. Get rid of the anti-trust exemption, make the insurance companies compete! Get rid of the lawyers with tort reform!

But one sobering concept to remember if national health care passes, the only similarities between what kind of treatment we get, how often, for how long, now vs. then will be in the spelling of the words. It will be apples to oranges...