FYI Medicare and CCSVI

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

Postby Donnchadh » Mon May 23, 2011 7:50 am

To put the earlier quote into context, that given was before I had my procedure with Dr. Makris. Medicare did indeed cover this procedure. I think the key is to code the procedure as treatment for venous problems (which when you think about it is a more accurate description) rather then as a "cure for MS."

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Postby dianabee » Mon May 23, 2011 8:03 am

Donnchadh wrote:To put the earlier quote into context, that given was before I had my procedure with Dr. Makris. Medicare did indeed cover this procedure. I think the key is to code the procedure as treatment for venous problems (which when you think about it is a more accurate description) rather then as a "cure for MS."

Donnchadh


I guess I would be unwilling to be treated by any physician who's office would code this procedure as a treatment for ms. Of course, as dr. S pointed out, this is not treating ms. It is treating a venous problem. The link to ms is far from scientifically proven, although we are highly suspicious!
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medicare

Postby zinamaria » Mon May 23, 2011 9:19 am

Okay, the issue I have reading all this is this: Even if the doc codes you for venous issues, what does it matter if your insurance co knows you have MS? In a perfect world, we would not even be discussing this, perhaps, if the insurance co and medicare could keep CCSVI and MS separate!! But it seems from what is reported is that they can't seem to do that. WE are doing it, but are they going to do it?? That's the important question, it seems.
And it IS discrimination if they do not allow coverage for me, for example, even if perfectly coded by the doctor on the paper work as venous issues, but they cover those without MS with the same issues.

But what to do about it? Yes, I will appeal if denied. But my question is this: we here on this forum know how all this SHOULD be handled, but has anyone been turned down that had the codes on paper work for venous issues, and NOT MS?
I thought I remember Dr. S saying he never mentioned MS and STILL BC/BS denied coverage.

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medicare (US) coverage

Postby dianabee » Mon May 23, 2011 10:24 am

First, I believe this thread is in reference to Medicare in the US; not private insurance, or medicare in other countries such as Canada or Australia. I believe there is another thread regarding a specific private insurer, and that is a seperate issue.

Regarding Medicare in the US, I have not heard from any patient who has been denied coverage or who is appealing a denied claim for this. If someone is out there, please speak up. I would like to hear from you, because if coded correctly, the claim should be paid and if it is not, you have a potential discrimination case.

I have seen a post or two where a facility indicated that claims were denied by Medicare. It was not clear how these claims were coded, or whether the claim(s) were resubmitted and then paid.

I have seen a post or two where a facility indicated they were no longer accepting medicare. This is very different from a claim being denied. If they are no longer accepting Medicare, it just means they won't take assignment, for whatever reason (late payments, low payments). It does not mean that Medicare will deny the claim (submitted by patient) if it is coded correctly.

I guess by "coded correctly" I mean coding that reflects a venous abnormality. NOT a procedure to treat MS.
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Postby 1eye » Mon May 23, 2011 12:17 pm

Medicare in US vs Canadian "Universal" Discrimination against diagnosis of 'MS':

It's very funny (not ha-ha) how the winds of politics and public opinion shift. We just elected, with a nice comfortable majority, a guy whose fondest dreams are to out-Bush George, take Canada apart at the seams, and get a good price for the bits, while at the same time you have a president who wants to get rid of the inequity in health care and make it more like the Canadian system. The party that represents the ordinary people in Canada is in Opposition, only able to complain, for another four or five years. At the death rate we know about in Canada, that will be up to two thousand deaths later.

When I was a kid there was a guy who transplanted the first heart. I think it's probably insurable now, but for a while there, it was likely only for rich people and lucky people. I hope this procedure matures something faster. I hope government and private insurers think past the next quarter, realizing that long money is smarter money, investing in people's future life more than their present peril.
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Postby WordWarrior » Tue Jun 07, 2011 12:13 am

My Albany procedures this past December were mostly covered by Medicare (except about a thousand out of fifteen). However, I last week went to a local IR w/ some CCSVI background who told me Medicare is no longer covering it.
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Postby WordWarrior » Tue Jun 07, 2011 12:16 am

Forgot to say... US Medicare and even though I didn't "technically" have CCSVI, only moderately and mildly stenosed IJ's, I was helped immensely by the angio--fatigue and cognitive problems MUCH improved.
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Postby 1eye » Tue Jun 07, 2011 5:32 am

Even if appeals are successful, they should not have to take place. Insurance companies do not have a duty to their stockholders to make every possible effort to discriminate against claimants.
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Coverage

Postby dianabee » Sat Jun 11, 2011 6:51 pm

WordWarrior wrote:My Albany procedures this past December were mostly covered by Medicare (except about a thousand out of fifteen). However, I last week went to a local IR w/ some CCSVI background who told me Medicare is no longer covering it.


That is interesting. I had the procedure 2 days ago; I double checked again with the insurance admin and she was very clear that Medicare is covering it. I can only surmise that your local IR is coding the procedure differently, or they have decided not to accept Medicare for whatever reason.

Of course, if, in a few weeks I get a claim denial letter, I'll be back on this thread and you may even hear me shrieking all the way from Delaware! :)
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Postby civickiller » Sun Jun 12, 2011 7:01 am

1eye wrote: Insurance companies do not have a duty to their stockholders to make every possible effort to discriminate against claimants.


incorrect

1eye wrote: Insurance companies do have a duty to their stockholders to make every possible effort to discriminate against claimants.


corrected

they do as much as they can to save a buck

ccsvi for ms - not covered
correction for vascular disease - covered
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Postby munchkin » Sun Jun 12, 2011 8:37 am

If you have MS in Canada you can't even talk to an IR regarding vascular health. Every medical person I've talked to tells you to talk to your neuro and see if he will refer you to an IR. That is something I have never heard of happening, besides the fact that it would take approx 6 months to get an appointment because it's not for a relapse follow-up.

The American system has issues but at least in the states you can talk to an IR. I'm a strong believer in Canada and the right for everyone to have equal access to medical care but right now I would rather be an American.

Sorry for the rant, it's been a bad CCSVI weekend.
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Postby Cece » Sun Jun 12, 2011 8:58 am

munchkin wrote:The American system has issues but at least in the states you can talk to an IR. I'm a strong believer in Canada and the right for everyone to have equal access to medical care but right now I would rather be an American.

That's just it, right now you do not have equal access to medical care. Non-MS patients with outflow obstructions in their jugulars do not need to consult neurologists before consulting vascular specialists; that would just be odd.
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Postby IHateMS » Wed Jun 22, 2011 3:32 pm

i do not read much here (Tims) any longer.... too many new, irrelevant topics daily....
i do have a ?

will medicare pay for ccsvi treatment?
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