FYI Medicare and CCSVI

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

Postby CCSVIhusband » Wed Dec 01, 2010 12:36 pm

AGAIN ... this was dated 11/18 ...

let's not forget medicare paid for several treatments just last week ...

please don't get everyone worked up speculating.
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Postby Donnchadh » Wed Dec 01, 2010 12:43 pm

CCSVIhusband wrote:AGAIN ... this was dated 11/18 ...

let's not forget Medicare paid for several treatments just last week ...

please don't get everyone worked up speculating.


It is quite possible that the claims paid last week were submitted months before the date of this letter.

What counts is what the official Medicare policy is going forward. The key wording is "and will be denied." That's future tense.....

Donnchadh
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Postby CCSVIhusband » Wed Dec 01, 2010 1:05 pm

I was talking about other insurance (private insurance) more or less - as well as medicare to a degree.

Venous stenosis is a known disease (vascular disease I should say), and there are several versions, Budd-Chiari, May Thurner ... SVC syndrome ...

They can't deny it ...

On top of that, I think people on this board have forgotten (again) that we shouldn't be putting some of the information out there that has been getting out there again. It used to be doctors names ... now I see postings about the coverage codes for some of these things ... (is that really wise?)
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Postby IHateMS » Wed Dec 01, 2010 1:07 pm

private insurance WILL follow medicare's lead.
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Postby Donnchadh » Wed Dec 01, 2010 1:36 pm

Just got off the telephone with the contact person for the medical clinic that was going to do my procedure, and she was stunned.

She wanted the letter sent to her so she could send it to their other clinics to see what's happening.

Will let me know, but she said that if Medicare won't cover this the private insurance carriers would be extremely unlikely to do so either.

Bad news, getting worse.....

Donnchadh
Kitty says, "Take that, you stenosis!"

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Postby CCSVIhusband » Wed Dec 01, 2010 1:41 pm

PLEASE ... stop scaring everyone and making statements that are not confirmed or true.

This is getting out of hand ...

A LOT OF PEOPLE ARE SCHEDULED FOR LIBERATION ALL OVER THE US ... IT'S NOT LIKE IT'S ALL GOING TO SHUT DOWN TOMORROW. IT JUST ISN'T GOING TO HAPPEN THAT WAY.

PEOPLE SCHEDULED WILL STILL GO, AND WE'LL SEE WHAT HAPPENS.

MARK MY WORDS.
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Postby Donnchadh » Wed Dec 01, 2010 1:46 pm

May I suggest you don't yell....I don't like this development any more then you do.

Anyone having a procedure scheduled might consider it prudent to double-check on their insurance coverage, or be prepared to pay for it themselves.

I certainly hope that Medicare will reverse their position on this.

Donnchadh
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Postby Cece » Wed Dec 01, 2010 2:06 pm

Donnchadh wrote:I am afraid that this ruling will effect all future Medicare determinations, not just this particular practice.

Also, I would not be surprised if private insurance carriers use this Medicare ruling as a basis for denying claims, as it is now considered to be officially "experimental."

A severe setback for CCSVI treatment-unless you have cash to pay for treatment.

A totally depressed and bummed out, Donnchadh

That is the worst case scenario. :(
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Postby CCSVIhusband » Wed Dec 01, 2010 2:12 pm

Like I said Cece ... just watch in the coming days and weeks how many people continue to use private insurance and have this done.

I can't speak to medicare ... (and I've made my feelings known about the government's involvement in healthcare - eventually it always runs out of money).

But this private insurance pool isn't just going to dry up right away ... if at all.

venous stenosis is a known disease like I said ... doctors will treat it. Maybe we need to get CCSVI alliance involved right away to head some of this off.

I think some people are knee jerking pretty bad right now ...
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Postby Cece » Wed Dec 01, 2010 2:27 pm

more of the letter:
Re: Venogram and Venoplasty for Multiple Sclerosis
Dear Dr. Roddy:

I have received your Octover 21, 2010 letter requesting coverage and billing for the performance of venograms and venoplasties in patients with multiple sclerosis (MS).

[…edited out trial information] All services (diagnostic and therapeutic) associated with such a trial are also non-covered and non-reimbursable, including testing that might be required to determine whether the beneficiary is eligible for entry into such a trial.

Your have also requested coverage and reimbursement for Medicare-coverage and reimbursement for these same services outside of a clinical trial. Included with your letter were the following articles from the medical literature:

* Zamboni, P, Consorti G, Galeotti R., Gianesini S, et al, "Venous Collateral Circulation of the Extracranial Cerebrospinal outflow Routes", Current Neurovascular Research 2009, 6:204-212
* Zamboni, P, Galeotti R, Menegatti E, Malagoni AM, et al, "A prospective open-label study of endovascular treatment of chronic cerebrospinal venous insufficiency, " Journal of Vascular Surgery 2009, 50:1348-1358
* Zamboni P, Galeotti R,Menegatti E, Malagoni AM, et al, "Chronic cerbrospinal venous insufficiency in patients with multiple sclerosis," Journal of Neurology Neurosurgery and Psychiatry 2009, 80:392-399

The first article describes the venous circulation in detail. The second describes the prevalence of venous obstruction in patients with MS and the third article reports results of venoplasty in such patients. These last two articles report a small study population (65 beneficiaries) and it is unclear whether these are even a different study population. The group is subdivided into three sub-groups of relapsing-remitting, primary progressive and secondary progressiv forms of the disease, further reducing the statistical and clinical significance. The treatment reults reported varied with the type of MS identified. The authors state the importance of additional longitudinal studies before accepting venoplasty as standard treatment for MS.

You have provided one article reporting a single site study with treatment of 65 patients, stratified into even smaller groups, followed for onley 12-18 months. However the trial that you alternatively proposed is to enroll 600 patients. It appears that diagnostic venography and venoplasty is not yet standard of care and remains investigational.

Therefore these services remain Medicare non-covered and non-reimbursable, even when performed outside of a clinical trial. All diagnostic tests for the purpose of identifying MS patients with venous obstruction (eg ultrasound, contrast venography, etc) as well all services related to the treatment of such obstructions (eg venoplasty) and all related services are considered not reasonable or necessary, and will be denied.

I regret that my response could not have been more favorable.

Sincerely,
Paul G. Deutsch
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Postby Cece » Wed Dec 01, 2010 2:41 pm

CCSVIhusband wrote:Like I said Cece ... just watch in the coming days and weeks how many people continue to use private insurance and have this done.

Selfishly, can we say months and not just days and weeks? I'm due to be treated at the end of January, under private insurance, and it's been enough of a roller coaster already.

This line to me is part of the problem:
The authors state the importance of additional longitudinal studies before accepting venoplasty as standard treatment for MS.

This denial is of venoplasty as a treatment for MS. But our IRS aren't treating MS, they are treating outflow obstructions and a variety of congenital malformations of the veins.
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Postby CCSVIhusband » Wed Dec 01, 2010 3:33 pm

PLEASE read Joan's Facebook quotes about this topic in this forum. This is a known venous disease (like I've been saying) ...

They can't deny coverage of a known condition ... this is why it needs to be separated from MS ... treat the venous disease.
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Standard of Care

Postby Kate_PghPA » Wed Dec 01, 2010 9:39 pm

Medicare DOES pay for Venous Obstructions to be removed via Angioplasty...
as for Renal Dialyisis patients...they ARE on Medicare...End Stage Renal Disease.

Leave MS out of the equation...if a pwMS is tested and shown to have Venous Compression, etc. Angioplasty IS the STANDARD of Care!!

...and as a retired Nurse Claim Reviewer for national insurance co., I say:
Always, Always Always Appeal any Denials you get from Insurers!!!
Few beneficiaries do ! IT Pays to APPEAL!
Last edited by Kate_PghPA on Thu Dec 02, 2010 6:24 am, edited 2 times in total.
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Postby CureIous » Wed Dec 01, 2010 9:49 pm

Donnchadh wrote:
I am afraid that this ruling will effect all future Medicare determinations, not just this particular practice.

Also, I would not be surprised if private insurance carriers use this Medicare ruling as a basis for denying claims, as it is now considered to be officially "experimental."

A severe setback for CCSVI treatment-unless you have cash to pay for treatment.

A totally depressed and bummed out, Donnchadh


It is depressing, it's all about precedence, not getting the proper boxes check next to the proper ICD codes. Pursestrings and check-cutters.


Quoting an earlier post by myself, forewarned is forearmed. If ya gonna do it, nows a good time. http://www.thisisms.com/ftopic-13672-0- ... rance.html

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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Medicare covers procedure

Postby dianabee » Mon May 23, 2011 7:56 am

There are a couple of different threads out here about Meficare denying coverage. First let me say I have not seen any posts where a patient has actually received a denial letter from Medicare. I have seen only references about it from provider offices and one letter where they said they would not cover the procedure as a treatment for MS.

I am scheduled to have my procedure in June so naturally I have been watching this topic and related threads closely.

I spoke with the insurance administrator this morning at the facility where I will be treated (a facility that was mentioned on this forum as one that no longer accepts Medicare). I was told quite definitively that yes they accept Medicare and no she does not recall that they have ever NOT accepted it, and she is unaware of any Medicare claims being denied there. She assures me that as the insurance admin she would know if this had occurred.

So I guess bottom line, believe only half of what you read. Verify your own coverage with your provider. Don't panic. And above all, have faith!

I'll report back after my procedure, on the appropriate thread.
Exciting times!!
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