Get treated ASAP if you want insurance to cover it
- carollevin
- Family Member
- Posts: 69
- Joined: Sat Apr 09, 2011 2:00 pm
Cece,
I am pretty sure that is exactly what it means--the effective date is when the change takes effect. If the procedure is done after the decision was made but before the "effective date," then the procedure should be covered. I am not in the health insurance business, but I think that most likely is what they mean.
I am pretty sure that is exactly what it means--the effective date is when the change takes effect. If the procedure is done after the decision was made but before the "effective date," then the procedure should be covered. I am not in the health insurance business, but I think that most likely is what they mean.
http://www.facebook.com/note.php?note_i ... nts&ref=mf
Letter from the doctor, test results and relevant xrays (MRIs/MRVs/doppler results) would all be individually obtainable.
Do we have two articles from respected journals with results of studies performing the procedure?Sometimes physicians do find cases in which elective procedures are medically necessary. To get these types of procedures covered, HealthSymphony, a comprehensive health insurance Web site, offers some suggestions on steps you can take get the services you want. You must provide the insurance company with sufficient medical data about the procedure to justify its coverage. This requires research. You need to find at least two articles from respected medical journals that provide the results of studies performed regarding the procedure. You also need to obtain a statement of medical necessity from the physician who is requesting the treatment. If your doctor truly believes that the procedure is necessary to improve your health and quality of life, the chance of receiving coverage from your health insurance provider greatly increases. All of the information you gather will be presented for consideration in front of the medical board and medical director of the health plan.
The information you provide initially may not be enough, and coverage for these experimental and cosmetic procedures may still be denied. In this case, you should contact your insurance company directly and state your case. Do this by writing an appeal letter, and include statements regarding the necessity of the procedure from your physician or surgeon. You will also want to provide all relevant test results and x-rays to help prove your case.
Letter from the doctor, test results and relevant xrays (MRIs/MRVs/doppler results) would all be individually obtainable.
First of all, does anybody know of a 501(c)(3) out there with a mission statement related to advocating for CCSVI coverage (with or without MS)? If so, we all need to know about them and support them. If not, it needs to be incorporated.
Second, does anybody know if the MS Society has an active role in CCSVI treatment advocacy?
Finally, assuming it does not exist...
Do we have any attorneys, businessmen (or businesswomen) or other capable people that would be willing to lead this charge? I wish it could be me, but it can't.
Ultimately, we need a high-power advocate. Being denied treatment for something that is covered in non-MS patients is unfair and unjust.
Second, does anybody know if the MS Society has an active role in CCSVI treatment advocacy?
Finally, assuming it does not exist...
Do we have any attorneys, businessmen (or businesswomen) or other capable people that would be willing to lead this charge? I wish it could be me, but it can't.
Ultimately, we need a high-power advocate. Being denied treatment for something that is covered in non-MS patients is unfair and unjust.
- 1eye
- Family Elder
- Posts: 3780
- Joined: Wed Mar 17, 2010 3:00 pm
- Location: Kanata, Ontario, Canada
- Contact:
Especially those "MS" patients who have no other disease modifying treatment.Being denied treatment for something that is covered in non-MS patients is unfair and unjust.
That's what Tim Donovan of Angioplastyforall is fighting for in Canada. I assume there is reverse advocacy coming from both national "MS"SocS. There needs to be a nationwide American class action. This is one case where litigation is a good thing. So far no high profile class action lawyers have stepped up, but they might begin to see daylight now that Serono has had its scandal, and now that science is beginning to hit paydirt in a lot of areas (genetics, pediatrics, mitochondria, iron deposition, imaging, plethysmography, haemodynamics, 2000 Google Scholar hits). I think they are still shopping for a neurology witness. I can think of a few, but they are probably busy. Do you have Dr. Hubbard's phone number?
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Not a doctor.
"I'm still here, how 'bout that? I may have lost my lunchbox, but I'm still here." John Cowan Hartford (December 30, 1937 – June 4, 2001)
Not a doctor.
"I'm still here, how 'bout that? I may have lost my lunchbox, but I'm still here." John Cowan Hartford (December 30, 1937 – June 4, 2001)
The July 1st medical policy bulletin is out, with no mention of CCSVI or venoplasty in MS. Yay.Cece wrote:www.unitedhealthcareonline.com/b2c/CmaA ... 007740dc0a____
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....
None that I know of. CCSVI Alliance is a 501(c)(3) but they have not considered this to be within their mission.jgalt2009 wrote:First of all, does anybody know of a 501(c)(3) out there with a mission statement related to advocating for CCSVI coverage (with or without MS)? If so, we all need to know about them and support them. If not, it needs to be incorporated.
Second, does anybody know if the MS Society has an active role in CCSVI treatment advocacy?
Finally, assuming it does not exist...
Do we have any attorneys, businessmen (or businesswomen) or other capable people that would be willing to lead this charge? I wish it could be me, but it can't.
Ultimately, we need a high-power advocate. Being denied treatment for something that is covered in non-MS patients is unfair and unjust.
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- Family Elder
- Posts: 255
- Joined: Thu Apr 17, 2008 2:00 pm
- Location: Michigan
- Contact:
BCBS & AAC billing
Update:
The bad news is that I am STILL waiting for reimbursement from AAC.
The good news is that the BCBS rep indicated that Empire BCBS of NY views the procedure as experimental but BCBS of Michigan does NOT!! So that is GREAT news for those of us in MI with BCBS!!
The bad news is that I am STILL waiting for reimbursement from AAC.
The good news is that the BCBS rep indicated that Empire BCBS of NY views the procedure as experimental but BCBS of Michigan does NOT!! So that is GREAT news for those of us in MI with BCBS!!
- carollevin
- Family Member
- Posts: 69
- Joined: Sat Apr 09, 2011 2:00 pm
Newlywed,
How did you find out your state will cover? I am in Florida. I have been reluctant to call BCBS of Florida and point out that I have MS and am going for CCSVI, because I don't want to make an issue out of something that maybe they wouldn't have had a problem with in the first place. Thanks.
How did you find out your state will cover? I am in Florida. I have been reluctant to call BCBS of Florida and point out that I have MS and am going for CCSVI, because I don't want to make an issue out of something that maybe they wouldn't have had a problem with in the first place. Thanks.
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- Family Elder
- Posts: 255
- Joined: Thu Apr 17, 2008 2:00 pm
- Location: Michigan
- Contact:
Carol - in my ongoing dialogue with BCBS of Michigan, the rep just mentioned it in passing. But what I did prior to my procedure was get the diagnosis & procedure codes (including ultrasound) from the provider. Then I called BCBS and asked if they were covered by my insurance. I did not mention MS then nor now. I know you already know this but I want everyone to always note the date/time, person you talk with and result of the conversation - those calls really are recorded/monitored and if need be, can verify information that was discussed.
Re: BCBS & AAC billing
I wonder if this means that BCBS of Michigan just hasn't moved as quickly with drafting the policy stating it is experimental or does it mean that they considered it, decided it wasn't experimental, and it will continue to be covered. I really would like it if events turn that way.newlywed4ever wrote:Update:
The bad news is that I am STILL waiting for reimbursement from AAC.
The good news is that the BCBS rep indicated that Empire BCBS of NY views the procedure as experimental but BCBS of Michigan does NOT!! So that is GREAT news for those of us in MI with BCBS!!