Having insurance pay for procedure=fraud

A forum to discuss Chronic Cerebrospinal Venous Insufficiency and its relationship to Multiple Sclerosis.

Having insurance pay for procedure=fraud

Postby CureIous » Fri Sep 10, 2010 3:24 pm

Or so sayeth the blogosphere.

Come come now, this is barely worth a mention, other than it's yet another blogmeister attempting to sound scholarly and balanced, and at the same time making dogmatic pronoucements. I mean really, can't have it both ways. Either you are "fair and balanced", or it's just another skewed, half educated view. You may not find CCSVI in the textbooks, but mentions of blood flow in MS? It's not a matter of references, rather how many you'd like to read...

Then accusing treated patients of fraud, now that's a belly buster. Oh really? My dumb and naive insurance company just wrote out a 50k check cause we said so, no path reports, no scans to pore over, no identifiable conditions, just my word as I snuck in my nebulous CCSVI condition in the back door under a ruse.

Trevis Trevis Trevis. Seriously, you claim to be a fellow MS'er, and at the same time accuse your fellow MS'ers who've went this route of abject fraud? Not even going to dignify that tripe with a response.

Normally I wouldn't get worked up over what some blogger clamoring for hits has to say about a particular thing, but the header on the blog had me saying, "here we go again, peanut gallery time". So sad it's from a fellow MS'er. Note I haven't taken umbrage at his piecemeal CCSVI refutation, rather at his characterizations along with the "give me hits" headline...

http://www.everydayhealth.com/blog/trev ... t-a-fraud/
RRMS Dx'd 2007, first episode 2004. Bilateral stent placement, 3 on left, 1 stent on right, at Stanford August 2009. Watch my operation video: http://www.youtube.com/watch?v=cwc6QlLVtko, Virtually symptom free since, no relap
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Postby nicknewf » Fri Sep 10, 2010 3:27 pm

Not fraud if you disclose. I have seen contracts with insurers in which a pwMS contractually agrees to forego the same value of MS drugs in exchange for the cost of the treatment.
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Postby CureIous » Fri Sep 10, 2010 3:31 pm

nicknewf wrote:Not fraud if you disclose. I have seen contracts with insurers in which a pwMS contractually agrees to forego the same value of MS drugs in exchange for the cost of the treatment.


Interesting. I was close to maxing out my DMD coverage anyways so that would have been a moot point on my end, but that is very intriguing nonetheless...I think I talked to my insurance co. at least half a dozen times prior to this. Long as you get the little codes in the proper spots and have docs to back it up, no problem. There was nothing that wasn't laid out on the table.

Plus, to speak in my own dogmatic fashion, I GOT MY MONEY'S WORTH lol.

I wuv my stents. Just mine, nobody else's...
RRMS Dx'd 2007, first episode 2004. Bilateral stent placement, 3 on left, 1 stent on right, at Stanford August 2009. Watch my operation video: http://www.youtube.com/watch?v=cwc6QlLVtko, Virtually symptom free since, no relap
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Postby hannakat » Fri Sep 10, 2010 3:34 pm

ummm..... so why give the link if not to provide him with more hits? Never heard of the guy and have no interest in visiting his site.

There's enough BS around already....who needs more negativity or stupidity in their life? It's easy enough to find without going out looking for it..... No thank you.

Yea, pain sometimes makes me hissy.
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Postby CureIous » Fri Sep 10, 2010 3:51 pm

hannakat wrote:ummm..... so why give the link if not to provide him with more hits?

Yea, pain sometimes makes me hissy.
~^,,^~


Yes, I've asked myself that on about 1,000 posts that have come out, most when there is a negative CCSVI article to be had in 10 different incarnations.

This was particularly eggregious coming from his particular mouth, having the scope of audience that he does. In fact if you look on some of his earlier postings, there's nary a hint of this abject horror at the atrocities being perpetrated by the CCSVI community. Many of our own landed in his comments section on earlier postings.

I recommend to sign up for google news alerts for CCSVI, get an interesting view from across the spectrum.

This is why I hate primary posting any more, get more flak than discussion. It's not about his particular hit count, that's up there high enough to land on the google news alert on a regular basis.
RRMS Dx'd 2007, first episode 2004. Bilateral stent placement, 3 on left, 1 stent on right, at Stanford August 2009. Watch my operation video: http://www.youtube.com/watch?v=cwc6QlLVtko, Virtually symptom free since, no relap
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Postby blossom » Fri Sep 10, 2010 5:22 pm

hannakat, you pretty much said it all in a nutshell! if being hissy now and then helps so be it.
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Postby CureIous » Fri Sep 10, 2010 5:28 pm

sorry I mentioned it. Good grief.
RRMS Dx'd 2007, first episode 2004. Bilateral stent placement, 3 on left, 1 stent on right, at Stanford August 2009. Watch my operation video: http://www.youtube.com/watch?v=cwc6QlLVtko, Virtually symptom free since, no relap
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Postby Trish317 » Fri Sep 10, 2010 5:42 pm

CureIous wrote:sorry I mentioned it. Good grief.


Don't apologize. There are many links posted here to negative things about CCSVI.

I've read this man's blog in the past when I started all my research on MS. Inevitably, clicking on things takes one to thousands of places. It appears that he has a relatively strong presence in the online MS community. I wanted to respond to what he wrote but, considering the fact that my darling man will have the procedure, in Albany, this coming Tuesday, all I could think to say was "Shame on you, Trevis."

I hope people will comment and refute what he's saying....with accurate information and complete respect, of course.
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Postby Johnson » Fri Sep 10, 2010 6:04 pm

CureIous wrote:sorry I mentioned it. Good grief.


Don't be.

I'll bet that everyone (but me) clicked the link. You, CureIous, ought to know what happened to the cat. Me? I'm just a lazy ol' hound.

Thanks for the summary.
My name is not really Johnson. MSed up since 1993
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Postby CureIous » Fri Sep 10, 2010 6:36 pm

Trish317 wrote:
CureIous wrote:sorry I mentioned it. Good grief.


Don't apologize. There are many links posted here to negative things about CCSVI.

I've read this man's blog in the past when I started all my research on MS. Inevitably, clicking on things takes one to thousands of places. It appears that he has a relatively strong presence in the online MS community. I wanted to respond to what he wrote but, considering the fact that my darling man will have the procedure, in Albany, this coming Tuesday, all I could think to say was "Shame on you, Trevis."

I hope people will comment and refute what he's saying....with accurate information and complete respect, of course.


Thank you Trish. This was very surprising not just that someone somewhere on the internet said something disagreeable about CCSVI, no shortage there, but as you intimate, the source and the incredible gotcha type headline, then of course the agreement from a fellow blogger with a link to his blog stating said same.

I do like to keep my finger on the CCSVI pulse (pun intended), by subscribing to the news alerts. Get some interesting finds both pro and con. One gets to watch the news cycle flourish, followed by the inevitable blog entries hither and yon. It's a big picture cross section of what is happening, and what is being talked about presently on the internet, plus some interesting perspectives and/or videos that I would have never seen in the course of a day..

I guess I just got this thing on haranguing people's personal decisions that they make in the pursuit of relief from their disease. I provide links because that's just how I operate, like to document where my info is coming from so people can make up their own minds if they decide to pursue further. Full disclosure as they say. Sometimes though it's just better to let the very opinionated, poorly researched stuff go by the wayside, but at the same time point out that regardless of what is being said about us "rabid CCSVI people", whatever that means, it is helpful to see what is coming down the pike. The post by nick is particularly intriguing. Contracts with insurers for treatment vs. drugs? Wow that's a new one.

Makes one wonder what will come next. Seeing as this is the ONLY avenue for many in the U.S., to get their insurance to pay, which is of course what our Canadian brothers and sisters are lobbying for at this moment, any hint of "going there" when it comes to outright claims of fraudulent activity on the part of the MS patient is something we should all be paying very very close attention to, especially when said claim comes from someone with a widespread audience, and MS to boot (which gives you special permission to let er rip of course)

The fact of the matter is, blogs are regarded nearly as high, if not higher than media outlets. The days of "if it doesn't make the news it isn't worth checking out" are long long gone.
Unfortunately, once again, they are afforded much leeway in subject matter, and about .01 to .00% in accountability to their readership. If someone sets themselves up high as an authority on a subject, well who is to say they aren't? One of the perks of such a position, is you have full control over what gets on the page, and what doesn't.

Anyways I thought it was a spurious, not well thought out argument, but at the same time the hint, mere hint of where the "shut it all down until high science bequeaths infallibility to the CCSVI model of creation" train of thought might be heading in the future, should give us all pause. When I went in, CCSVI was here, and >>there, and that's about it. I'm sure every insurance company has heard of it by now, and is formulating a reaction to it, either stasis, or amendment. Since CCSVI is being included (and we know this is correct, physiologically speaking) under the umbrella of 35476, 36012 and the rest of the treatment codes, blocked veins are blocked veins are blocked veins, all is well. If your insurer covers it, you can get treated. Period. Up until this point, the battle has been finding someone to treat you, that you trust.

But as has happened quite frequently that I have seen in this unique paradigm since delving in mid last year, where we think/want things to go, and where they truly end up, seem to diverge proportionally to how much we want them. So instead of big universities jumping on the big study bandwagon, we get dribs and drabs here and there, all so far inconclusive or lacking in that defining moment that will set the ball rolling. Yes, I do think itsa comin, so hold on tight, but some need it NOW however, and any dillying around with the codes or hint, mere hint of "going there" as I said above, should not be taken lightly or as a mere internet rambling. Smoke=fire, most of the time..

And of course, since getting anything treatment-wise now through an IRB is like pulling eye teeth blindfolded, patients could conceivably in the future, be faced with much fewer options, to wit:
1. Fly overseas, mortgage the house, do what you have to do, roll the dice.
2. Hope your insurance doesn't begin to get ahead of this, and force you to choose as nick stated above, or makes a specific exclusion for any type of CCSVI treatment as experimental, IF you are already dx'd with MS. And once one of them does it, finds a way to get those exclusions in there, the rest won't be far behind.
3. Wait on the studies to not only be completed, but accepted in academia, 5-10 years. Not "A" study, but the study(ies), confirming the studies, making CCSVI not just accepted, but embraced and pursued as a viable alternative to MS treatment, either concomitant with the DMD's, or instead of for the earliest dx'd cases.
4. Suggestions?

This is not to fearmong, focus on the negative, roll things up and call it a day, because something somewhere on the internet is amiss.

But, it is something to keep in mind for future reference. I have a sense we may be referencing this more very soon.

Mark.
RRMS Dx'd 2007, first episode 2004. Bilateral stent placement, 3 on left, 1 stent on right, at Stanford August 2009. Watch my operation video: http://www.youtube.com/watch?v=cwc6QlLVtko, Virtually symptom free since, no relap
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Postby hannakat » Fri Sep 10, 2010 7:29 pm

"You, CureIous, ought to know what happened to the cat. Me? I'm just a lazy ol' hound."



Nope, not this one....sorry. Don't have time or energy for it.

Not sure how someone's opinion about insurance fraud affects the 'positive' or 'negative' aspects of CCSVI at all. They're intelligent folks and understand what the business is about (the insurance companies). It's just clutter on the board that I've now contributed to. yea.

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Postby blossom » Fri Sep 10, 2010 7:50 pm

curious, don't be sorry and apologize. you only apologize if "you" did something wrong which "you did not." i don't think anyone responding meant anything towards you-it was the article. actually, sometimes it is good to feel a little hissy-it can tend to make a person stronger. we're all in the same boat here and info. is info. some we want to hear some we don't. but hey, it keeps us on our toes. it gets the blood flowing. i feel we are all wearing "white hats" here. does anyone here think they are purrrfect? i don't think so- none of us are-i know i'm not. so, it is what it is, we are what we are and we do what we do. and, for a bunch of sick people i think it is really amazeing. and, just like the guy that wrote that junk stuff-i'm sure they sneak a peek at this site. i can't help but feel that they only wish they had what we have-truth. so we all can put on our white hats even if we are feeling a little hissy at times.

hannakat, i love it.
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Postby Johnson » Fri Sep 10, 2010 8:12 pm

I was not referring to the hannakat in my reference to curiosity and cats - to be clear. I can rarely refrain from clicking links, but like hannakat,, I didn't have the time or energy.

Sad, isn't it?
My name is not really Johnson. MSed up since 1993
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Postby cheerleader » Fri Sep 10, 2010 8:58 pm

Hey Mark--
I clicked. Doh! Did you see the header at the top of this gent's blog....Drugs A-Z. Really? If you haven't seen it, don't click...trust me.

Here's some corporate info on Everyday Health, the company that houses his blog.
link

It's all about advertising, getting the eyeballs and making the benjamins. Funny story--YouTube has tried to get me to accept advertisers since I posted Dr. Zamboni's video and it's gotten so many hits. (54,000) I declined...since it's Dr. Zamboni's work, and I just uploaded it to the site after I got home from Bologna last year. Who knew?

Have a great weekend, Mark. I'm going to go over to Youtube and click on your video...it's great to watch, and maybe you'll get some paying advertisers.
PS....don't worry. Stenosis over 50% (some insurers are 80%) in the central veins (like azygos or jugulars) is covered by most insurance companies. There's a reason why it's covered.
xo,
cheer
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Postby MrSuccess » Fri Sep 10, 2010 9:57 pm

think you can '' trick '' an Insurance company ?

you might '' luck out '' ..... but I'd put my money on these guy's being smarter than you .

That's how they got all the $$$$ they have ............




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