[bub621]

Hi Everyone

I joined this group because I am in healthcare not a pain patient. 3 years ago my boss (doctor) told me I was going to be in charge of getting the Ketamine Infusion suite underway with the help of Dr Shwartzman in PA. I had no clue what it even was at the time.

After extensive research and training, we have been up and running for a year and a half in Maryland. I have learned so much from this and truely wish to keep learning. I have hit several obstacles with Ketamine and insurance. I have seen so much success with my patients and this treatment gives the patient and family hope. I dont want to see it fail. I am trying to reach out for help as to how the doctor office can help Ketamine Infusion Therapy get approved.

Please, I am not trying to start a debate on weather Ketamine works or not in your opinion. I just want info on how to get insurances to approve this. Any way that a physican can help the patient during the process.

I stumbled upon this site after googling "denied ketamine infusions by insurances" so I figure you guys have a great wealth of knowledge.

[nalakity]

Thank you for you work with pain patients. It's always nice to hear from someone who cares and is actively trying to make something happen. I hope someone here has some information that will help you on your quest. Please keep us updated on this if you could. I'd really appreciate it!

Originally Posted by bub621

Hi Everyone

I joined this group because I am in healthcare not a pain patient. 3 years ago my boss (doctor) told me I was going to be in charge of getting the Ketamine Infusion suite underway with the help of Dr Shwartzman in PA. I had no clue what it even was at the time.

After extensive research and training, we have been up and running for a year and a half in Maryland. I have learned so much from this and truely wish to keep learning. I have hit several obstacles with Ketamine and insurance. I have seen so much success with my patients and this treatment gives the patient and family hope. I dont want to see it fail. I am trying to reach out for help as to how the doctor office can help Ketamine Infusion Therapy get approved.

Please, I am not trying to start a debate on weather Ketamine works or not in your opinion. I just want info on how to get insurances to approve this. Any way that a physican can help the patient during the process.

I stumbled upon this site after googling "denied ketamine infusions by insurances" so I figure you guys have a great wealth of knowledge.

[Jimking]

My wife has had ketamine infusions at GW hospital in DC. Where are you located in Maryland? At first our insurance denied the coverage but quickly approved it. I can not remember all the details but I think it may have had more to do with the kind of insurance we had which was BCBS PPO. I have a hunch that if it was an HMO or some other for-profit it would have been denied. My wife's doctor may have mentioned to BCBS that this procedure will help.

Dr. Chin at GW had just started doing this procedure when my wife was treated. The procedure was a 4 day, 4 hour drip. Not sure of the amount of ketamine. It did nothing to help my wife. I'm curious to know more about your program. We are located in Northern Virginia.

[alt1268]

Bub,

It has been my experience most are denied. Below is a a link showing a recommendation from DEE another neurotalk patient who went through the denial process and appeal:

http://neurotalk.psychcentral.com/sh...mine+insurance

Hope this helps! GOD knows, I hope this helps.

[LIT LOVE]

I was approved for a 3 outpatient infusions after years of attempting to get approval. At the time of approval I had gone through all the hoops of getting the SCS approval, along with a 30 day inpatient program. The timing seemed coincidental. Ketamine is much less expensive than the SCS...

[reluctant@thetable]

Alt1268 provided the link to the most helpful information I am aware of. One other thing I would add is that my insurance co. (BC/BS PPO) told me that because they initially refuse most treatments that aren't covered, I could have my request sent directly to the appropriate person by labeling the envelope "urgent". That way it immediately ends up on the right person's desk.

I echo the "thanks for caring" others have expressed.

[betsykk]

we have had many inpatient /outpatient infusions approved by federal bc. no problems at all. talk to reddawn on this board. she is an admin of the ketamine klub on a popular social site that i am no longer allowed to promote. they have all the insurance documentation/codes on there. barby ingle has them as well. there are several people on these boards that are in healthcare that can help you.