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