Aetna

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Aetna

Postby WeWillBeatMS » Sun May 08, 2011 8:39 am

Found something promising from Aetna's website regarding angioplasty for stenoses or occlusions of major veins.

http://www.aetna.com/cpb/medical/data/500_599/0531.html

While it does not specifically mention the jugulars, the azygos, or even CCSVI for that matter it does say:

"Endovascular balloon dilation has been proven to be effective in a great majority of patients with stenoses or occlusions of major veins."

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Postby Cece » Sun May 08, 2011 8:55 am

It's saying that stents are experimental and investigatory for any uses other than the listed ones. This would mean that a stent for CCSVI would fall into the experimental/not covered category.

I agree about the part you quoted and I would define the jugulars as among the major veins...but then again it says majority and not all. We know that ballooning CCSVI obstructions has not yet been proven effective.
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Postby drsclafani » Sun May 08, 2011 8:51 pm

Cece wrote:It's saying that stents are experimental and investigatory for any uses other than the listed ones. This would mean that a stent for CCSVI would fall into the experimental/not covered category.

I agree about the part you quoted and I would define the jugulars as among the major veins...but then again it says majority and not all. We know that ballooning CCSVI obstructions has not yet been proven effective.


why do you say that. effective for what? outflow obstructions are present. we know that other conditions where jugular veins are obstructed have among their symptoms, confusion, fatigue, loss of balance, to name a few.
i would not surrender that point too quickly cece
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Postby Cece » Sun May 08, 2011 9:44 pm

My optimism has been dampened by the Empire BCBS medical policy document on CCSVI.

It doesn't even matter that Doepp was wrong, it's still in there.

Just as it might not matter that common sense says clearing obstructions will improve blood flow. It's investigatory for CCSVI because it's not proven for CCSVI specifically. :(

I agree about the other conditions. Superior vena cava syndrome, dialysis blocked jugulars, etc. But still it seems we are up against insurance companies that will willfully ignore such similarities.
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Postby WeWillBeatMS » Mon May 09, 2011 9:06 am

Dr. Sclafani,

Would you consider the azygos & the 4 jugulars "major" veins?

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Postby cathyb » Wed Jun 08, 2011 10:46 am

Has Aetna been covering the scan and treatment (if necessary)? I'm just curious. I have Aetna and an appointment at AAC on Monday the 14th. I can cover the scan if Aetna doen't, but if they find a problem (which in some ways I hope they do!) I am wondering if I'm on the hook for the procedure.

Oh, and on a personal note, I'm so nervous! I have researched this since December 2009 and can't believe I'm finally getting the ball rolling!
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Postby WeWillBeatMS » Wed Jun 08, 2011 1:12 pm

cathyb,

I have Aetna and I have been preapproved by Dr Sclafani's team to have the ultrasound in a few days and the procedure the next day, assuming they find CCSVI. We're in the same boat, as I first found out about CCSVI a month after you. Only I'm not nervous. I'm ready for this! :)

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Postby 1eye » Wed Jun 08, 2011 2:04 pm

drsclafani wrote:
Cece wrote:It's saying that stents are experimental and investigatory for any uses other than the listed ones. This would mean that a stent for CCSVI would fall into the experimental/not covered category.

I agree about the part you quoted and I would define the jugulars as among the major veins...but then again it says majority and not all. We know that ballooning CCSVI obstructions has not yet been proven effective.


why do you say that. effective for what? outflow obstructions are present. we know that other conditions where jugular veins are obstructed have among their symptoms, confusion, fatigue, loss of balance, to name a few.
i would not surrender that point too quickly cece


It is obvious on examination of any of the thousands of photographs taken via fluoroscopes of the corrective effect on outflow of venous blood. This procedure is exceedingly effective for that. It is exceedingly safe, and has the same, or lower, known rate of restenosis and other post-procedure problems as any other venous catheter-balloon dilatation procedure. There is nothing magic, sacred, or sacrosanct about these veins. Veins belong neither to cardiologists, neurologists, surgeons, nor radiologists. They belong to the patient.

The positive effect of normalized outflow on the CNS and on the rest of the body, cannot be understated, nor can the negative effect of deliberately leaving a major circulatory problem in place, on either the CNS or on the rest of the body. It is not an experiment to repair this problem. It is medicine.
"Try - Just A Little Bit Harder" - Janis Joplin
CCSVI procedure Albany Aug 2010
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Re: Aetna

Postby Cece » Fri Aug 24, 2012 3:41 pm

It's a year later and this is now listed for Aetna:
Aetna considers the following interventions experimental and investigational for MS:
Balloon angioplasty/venous angioplasty with or without stent placement

http://www.aetna.com/cpb/medical/data/200_299/0264.html

We might be switching to Aetna. Not good.
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Re: Aetna

Postby CureIous » Sat Aug 25, 2012 4:39 am

My friends niece just went in for scanning, she has Aetna fyi, she was quoted 2000 out of pocket for the scans (not covered), and with out of network (65%) for the procedure, total is 4975.00.
Horse's mouth, seen the email. YMMV
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Re: Aetna

Postby Cece » Sat Aug 25, 2012 1:35 pm

Thanks, that's encouraging that Aetna is covering the procedure for her. Hope she sees results.
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Re: Aetna

Postby CureIous » Sat Aug 25, 2012 3:48 pm

Will update as her scans are off to Detroit :) for eval.
I told her if she could, get to NY, she chose local and mostly covered by her insurance, its a sad reality not appreciated enough in the CCSVI community, that not everyone has unlimited resources to just pick the choicest pieces from the sampler platter, she has been duly warned repeatedly about the outcome possibilities and chose anyways to proceed, smart, vibrant, lovely young lady and I do wish her the best. Will keep posted as I get it.
RRMS Dx'd 2007, first episode 2004. Bilateral stent placement, 3 on left, 1 stent on right, at Stanford August 2009. Watch my operation video: http://www.youtube.com/watch?v=cwc6QlLVtko, Virtually symptom free since, no relap
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Re: Aetna

Postby Cece » Sat Aug 25, 2012 11:59 pm

CureIous wrote:its a sad reality not appreciated enough in the CCSVI community, that not everyone has unlimited resources to just pick the choicest pieces from the sampler platter

There are many many people who are priced out of getting the procedure at all. Or who got the procedure and restenosed. As a person who cares about people, I hate it.

But for picking a doctor, if you are self-paying, they are all in the same general range? Maybe a thousand dollar difference or so? I haven't been in the market so I don't know. So for self-paying, it makes sense to me to go if the best if you can determine who the best is, and there is more than one opinion on that!

With insurance, that's a very different situation, if it means paying out-of-pocket for the best versus paying much less but having to go in-network.
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Re: Aetna

Postby 1eye » Sun Aug 26, 2012 2:19 am

Quoting from myself:
It is obvious on examination of any of the thousands of photographs taken via fluoroscopes of the corrective effect on outflow of venous blood. This procedure is exceedingly effective for that. It is exceedingly safe, and has the same, or lower, known rate of restenosis and other post-procedure problems as any other venous catheter-balloon dilatation procedure. There is nothing magic, sacred, or sacrosanct about these veins. Veins belong neither to cardiologists, neurologists, surgeons, nor radiologists. They belong to the patient.

The positive effect of normalized outflow on the CNS and on the rest of the body, cannot be understated, nor can the negative effect of deliberately leaving a major circulatory problem in place, on either the CNS or on the rest of the body. It is not an experiment to repair this problem. It is medicine.


Use of angioplasty to treat "MS" is considered experimental and not covered. Will some brave lawyer go to bat for normalized outflow, or against deliberately leaving a major circulatory problem in place? How about damages for willful malpractice?
"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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