Reflex Sympathetic Dystrophy (RSD and CRPS) Reflex Sympathetic Dystrophy (Complex Regional Pain Syndromes Type I) and Causalgia (Complex Regional Pain Syndromes Type II)(RSD and CRPS)


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Old 11-01-2006, 09:22 PM #1
hideej76 hideej76 is offline
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Post Insurance Wont Cover My Block

Hello Everyone... Ugh, I swear Im feeling like Im taking two steps forward and three steps back!!!

Well as most of you have read on here, I seen my doc on Monday, and Im suppose to be having a lumbar sympathetic nerve block done this comming Monday, the 6th...

Well I get a call from the lady at his office today that schedules these procedures... She informs me that my insurance will not cover the block, because it is a outpatient procedure.... This doc doesnt except my insurance that I have, so I have been paying cash to see him... He only excepts Medicare and Medicaide... But, we didnt think it would be any issue for the insurance to cover since it was being done at the hospital that I work at... Its all part of my insurance deal... The doc is considered "out of network" ect... It would only be covered if it was an emergency outpatient procedure... Guess I dont understand the whole ordeal...

Does anyone have any suggestions?? I asked the lady what it would cost out of pocket... OMG not an option, doc fee alone would be around 2000, and that doesnt include anthesia, OR fees, ect... So said and done she thought about 7-8000... Not in my budget plan!!!

I just dont understand how insurance companies can turn a patient down when something is considered medically necessary!!! The doc office is suppose to call me back tomorrow, to see if I can explore anymore options, but she said she didnt think there was much to offer!

Does anyone know what could or would happen if I cant have this block done? Im still very early diagnosed with RSD, only about 3 months ago... Things for the most part are going alright, as in therapy, pain managment (varies from day to day) meds ect... I just think if a doc orders something like this to be done, there is a reason behind it! Anyone out there with any suggestions, would be greatly appreciated!! Im not a happy camper right now!!

Thanks All,
--Heidi
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Old 11-01-2006, 10:30 PM #2
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do u have an hmo or ppo? when my insurance doesn't say they cover something (i have an hmo) my doc calls like the head of the medical group to see if they can just push it threw. or try having ur primary get ur insurance to call it in...
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Old 11-02-2006, 04:48 AM #3
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I believe I have a PPO plan... My Neuro-Pain Management doc is considered out of network... He doesnt even take regular insurance at all... All he excepts is Medicare and Medicaide... The only reason he was going to take my insurance was because the block was a medical procedure that had to be done at a hospital... I was going to have this procedure done at the hospital I am employeed at... As an employee benefit if we have any type of surgery, treatment, hospitalization, ect, at the hospital we work at they give an amazing discount to the insurance company... This is another reason Im so confused to why they wont cover the block!!!

The doc office is calling me back tomorrow....So Im hoping, fingers crossed that they will have some options we can discuss on how to get around this or get it done!! I think Im going to mention that perhaps maybe they can refer me back to my Neuro-Surgeon that did my back surgery in Aug... Mayube he could do it? My insurance company covered all his costs along with the surgery with no problem! So we'll see!!!

Just darn it, Im in need of some good karma!! Im getting so frusterated!! It seems like if its not one thing, its another!! Can anyone tell me if I would not be able to have this block done, what could happen? Is a block that medically nesassary?? Is it just for pain control or does it help with other stuff?

Thanks All

--Heidi
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Old 11-02-2006, 10:55 AM #4
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Quote:
Originally Posted by hideej76 View Post
Can anyone tell me if I would not be able to have this block done, what could happen? Is a block that medically nesassary?? Is it just for pain control or does it help with other stuff?
Heidi, early on, blocks are extremely important for RSD. In "some" cases, it can stop the rsd. It's MOST beneficial in the early stages, when it's first caught, while the pain is still sympathetically dependent. Ihaven't had any blocks. My doctors have all said "it's too late" because mine is sympathetically INdependent now. However,mthe people here on the forum say I shoudl have it anyway. I'm goig to speak to my pain doc about it.

My personal suggestion to you is this: Use your insurance as it is INTENDED to be used...meaning, if it's a PPO and you need a pcp, then get a pcp and start there...go "in network" and have someone manage your care. See if you can get someone at the insurance company to be your "case manager" to help guide you and work for you and rally for you. Usually there is someone who can help you in that regard within the insurance company itself.

FYI...I haven't watched them yet, but here is a video of a block being done:

http://www.rsdfoundation.org/en/en_c...l#NEWNerveBLKS

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Old 11-02-2006, 02:55 PM #5
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Hey Lisa, Thanks for the link to that video...I just watched it! Very interesting!

--Heidi
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Old 11-02-2006, 04:19 PM #6
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Dear Heidi -

If you are still having trouble with the coverage, I would track down the "benefits manager" in your hospital, or it's holding company immidately and read him or her the Riot Act. Hint: a good place to start is by asking where in the literature that's given to plan members does this particular exclusion actually appear. It can't hurt. And time really is of the essence in the effectiveness of these things.

Good luck.

Mike
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