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 nellie » Thu Jun 02, 2011 4:14 pm

Thanks Cece!
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Postby Cece » Fri Jun 03, 2011 2:09 pm

Does anyone understand what is meant by the dates when the policies take effect?

If an anti-CCSVI policy is published June 1st with an effective date of July 1st, can you get treatment between June 1st and July 1st?
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Postby carollevin » Fri Jun 03, 2011 3:07 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.
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Postby Cece » Thu Jun 16, 2011 9:37 am

www.facebook.com/note.php?note_id=30537 ... nts&ref=mf
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.

Do we have two articles from respected journals with results of studies performing the procedure?
Letter from the doctor, test results and relevant xrays (MRIs/MRVs/doppler results) would all be individually obtainable.
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Postby jgalt2009 » Fri Jun 17, 2011 5:28 am

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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Postby 1eye » Sat Jun 18, 2011 5:37 am

Being denied treatment for something that is covered in non-MS patients is unfair and unjust.

Especially those "MS" patients who have no other disease modifying treatment.

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?
"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 » Mon Jul 04, 2011 8:41 pm

Cece wrote:www.unitedhealthcareonline.com/b2c/CmaAction.do?channelId=bfb296e9ca71e110VgnVCM1000007740dc0a____

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....

The July 1st medical policy bulletin is out, with no mention of CCSVI or venoplasty in MS. Yay.
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Postby Cece » Mon Jul 04, 2011 8:43 pm

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.

None that I know of. CCSVI Alliance is a 501(c)(3) but they have not considered this to be within their mission.
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BCBS & AAC billing

Postby newlywed4ever » Tue Jul 05, 2011 4:53 pm

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!!
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Postby carollevin » Tue Jul 05, 2011 5:07 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.
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Postby newlywed4ever » Tue Jul 05, 2011 5:27 pm

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.
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Re: BCBS & AAC billing

Postby Cece » Tue Jul 05, 2011 7:17 pm

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!!

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.
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