Get treated ASAP if you want insurance to cover it

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

Postby Cece » Fri May 06, 2011 6:54 pm

I was a little confused there for a minute. :)
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Postby carollevin » Fri May 06, 2011 7:14 pm

Sorry about that CeCe,
This brain fog thing can be pretty bad, and my brain used to be so sharp. It is proably the symptom that bothers me the most. 8)
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Postby 1eye » Fri May 06, 2011 7:49 pm

Uh, what were we just talking about?... :?
"Try - Just A Little Bit Harder" - Janis Joplin
CCSVI procedure Albany Aug 2010
'MS' is over - if you want it
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Postby carollevin » Fri May 06, 2011 7:59 pm

1eye wrote:Uh, what were we just talking about?... :?


I accidentally addressed a response to this topic to CeCe that I had meant to address to Newlywed. I was explaining that my mistake had to do with my brain fog. Sorry for the confusion.
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Postby pklittle » Sat May 07, 2011 8:03 am

1eye wrote:Uh, what were we just talking about?... :?


You need to get treated ASAP! :P
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Postby Cece » Sun May 08, 2011 7:41 pm

...if he wants to be treated under insurance
...which as a Canadian is not even an option
...then yes asap asap asap :)
...without rushing and with knowing what you are risking, etc. (those are valid points from earlier)

But as I read elsewhere, he is riding his trike bike for the first time in two years, and with better core strength than before, so congrats to you 1eye.

Once CCSVI goes onto the investigational procedures list on the medical policy for these insurance companies, how long does it take to get it off the investigational list?
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trike

Postby 1eye » Mon May 09, 2011 10:11 am

Hey, it's not just any trike. It's a Terratrike, and it's recumbent, in a tadpole design. It has three chainwheels in front, 8 gears on the rear hub, disc brakes, and handlebar shifters. I use clip-on sandals to keep my feet cool and because my left foot would otherwise slide off. So far I have not done a lot of walking at the far end, or the cleats would be a problem. I am very stiff and spasticky after riding it a while, but it's well worth it, and being still a few minutes clears that up. The amazing thing is getting in or out, which used to be a major operation (at one point I had a trapeze-like affair hanging from my garage that never worked very well), but now is easy. Only thing I have to do is chock the wheels because I have misplaced my velcro braking-strap.
"Try - Just A Little Bit Harder" - Janis Joplin
CCSVI procedure Albany Aug 2010
'MS' is over - if you want it
Patients sans/without patience
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Postby Cece » Thu May 19, 2011 6:04 am

Here's another BCBS provider with new policy: BCBS Georgia

www.empireblue.com/medicalpolicies/poli ... 136297.htm
SURG.00122
Venous Angioplasty with or without Stent Placement for the Treatment of Multiple Sclerosis
This policy addresses venous angioplasty (with or without stent placement) as a method to improve blood flow in an abnormal venous circulation, known as chronic cerebrospinal venous insufficiency (CCSVI), found in some individuals with MS.

Effective 7/1/2011.
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Postby Cece » Thu May 19, 2011 6:07 am

Also Community Connect Health Plan in SE Wisconsin and Pennsylvania.
www.cchmedicalpolicies.com/medicalpolic ... 136297.htm

effective 4/13/11
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Postby Cece » Thu May 19, 2011 6:12 am

BCBS South Carolina
effective 4/13/2011

http://scmedpolicies.wellpoint.com/medi ... 136297.htm
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Postby 1eye » Thu May 19, 2011 7:29 am

Federal and State law, as well as contract language, including definitions and specific contract provisions/exclusions, take precedence over Medical Policy and must be considered first in determining eligibility for coverage. The member’s contract benefits in effect on the date that services are rendered must be used. Medical Policy, which addresses medical efficacy, should be considered before utilizing medical opinion in adjudication. Medical technology is constantly evolving, and we reserve the right to review and update Medical Policy periodically.

This directive looks to have been hand-written by 'special interests' for the specific purpose of the type of discrimination we are seeing. I think the Academy of Neurologists has drawn its line in the sand, with a clear effect on the ability to afford treatment, the productive life of the population, and on the incomes of other physicians who are treating legitimate human health problems with real consequences on human suffering and reduction of harm. It is now up to other, competing, interest groups or those being discriminated against, or their representatives, to either shut down this despicable effort, or have the flow of income supporting this humane and proper work shut off at the source.

The fact that these people being treated have been (mis)diagosed as having 'Multiple Sclerosis' has no bearing on their need for this treatment. These treatments are being denied for two reasons: to preserve the fictions and theories surrounding the neurology profession's traditional domination of a patient population and this segment of the very lucrative drug industry which has been constructed to support it, and to avoid billing of legitimate claims for necessary medical treatments which result in improved human health, quality of life, and continued employment.

The fact that these orders are all worded similarly, and appeal to the sentimental tradition of the so-called 'MS Society' is extremely divisive of the more vulnerable of these people, causing them even worse stress and harm. The 'Society' has taken on the mission to spend large amounts of human and financial resources, in an effort to slow or prevent the progress of this treatment, because of its deep ties to the drug industry and the neurology profession, which has recently come under the harsh shadow of a kickback scandal concerning 'MS' drugs, also paid for by the same insurance industry, and seen by those doctors as competing with these vascular treatments. The opinions of this 'Society' are not unbiased.

The references quoted are carefully chosen from among many available papers on the subject to support the opinions of the bulletin and oppose the carefully chosen 'counter-evidence'. If other references were quoted, an entirely different, and more truthful picture would emerge.

The action of this memo is discrimination on the basis of previously existing illness and on widely disputed medical opinion.
"Try - Just A Little Bit Harder" - Janis Joplin
CCSVI procedure Albany Aug 2010
'MS' is over - if you want it
Patients sans/without patience
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Postby carollevin » Fri May 20, 2011 7:53 am

Thanks for posting CC. I have been reluctant to call my own state's BCBS to ask because I don't want to point out to them that I have MS and CCSVI--as they document every phone call and I don't want to point out something and potentially make it a problem.

What I don't understand is if the CCSVI treatment center codes to the insurance for only CCSVI treatment and testing codes and does not code the MS diagnosis, how can the insurances deny? As there is no way the insurance can know if the CCSVI and MS have any relation to each other. I guess that would be part of the theory in my appeal--if I needed to appeal.

Has anyone else out there been having trouble recently in being denied coverage with any U.S. insurances?
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Postby HappyPoet » Fri May 20, 2011 8:35 am

Carol,

I'll be having a follow-up ultrasound soon, and if Medicare denies payment just because of past costs related to a diagnosis of MS, I'll definitely appeal because I'm not even sure I have MS -- I was not tested for all the differentials (I'll be testing for Lyme first). I was rushed through the MS diagnosis and rushed onto the DMDs (gee, I wonder why).

My neuro problems are best explained by CCSVI and CCVBP (misalignment of skull base and top of spinal column which impinges nerves, veins, and arteries; explains demyelinating lesions).

If I need to appeal, I'll keep the forum updated on my fight which is very important because I'll be needing USs at 3 mos, 6 mos, 1 yr., and beyond.

Carol, thank you again for all your terrific help on this thread.

:)
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Postby Cece » Thu Jun 02, 2011 3:45 pm

www.unicare.com/medicalpolicies/policie ... 136297.htm

The latest health insurance to come up with the policy, worded the same.

Anyone know where Unicare is? "Unicare, A Healthy Dose of Innovation"
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Postby Cece » Thu Jun 02, 2011 5:06 pm

www.unitedhealthcareonline.com/b2c/CmaA ... 40dc0a____

Here's the link to where United Healthcare posts its new medical policies. The batch for June 1st (which would be effective July 1st) just came out with NO MENTION of CCSVI or venoplasty or MS.

Watching closely....
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