Medicare Denial For CCSVI Treatment!

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

Medicare Denial For CCSVI Treatment!

Postby Donnchadh » Fri Sep 30, 2011 8:03 am

Just got off the telephone with Dr. Makris' office concerning my upcoming post procedure ultrasound check. They had submitted it to Medicare for pre-approval and their corporate headquarter billing office just received notice that henceforth, Medicare will no longer cover any CCSVI procedure or treatment. That also includes post procedure care, like ultrasound testing and office visits. So unless you wish to pay the cost for an ultrasound, $450, in cash Medicare recipients are out of luck. Blue Cross is also denying coverage in Illinois.

The reason for denying coverage is that CCSVI is considered an experimental procedure.

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Re: Medicare Denial For CCSVI Treatment!

Postby nellie » Fri Sep 30, 2011 2:47 pm

Donnchadh---Thanks for the update. I know Dr. Cumming in Mpls. wrote in April patients were being denied but we haven't had an update since then. I think Dr. Sclafani had stated not long ago his patients had coverage with Medicare. I wonder if coding is the difference. If coding is not the difference I wonder why New York is different then Mpls. on coverage when it comes to Medicare. Does anyone know?
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Re: Medicare Denial For CCSVI Treatment!

Postby Donnchadh » Fri Sep 30, 2011 3:54 pm

nellie wrote:Donnchadh---Thanks for the update. I know Dr. Cumming in Mpls. wrote in April patients were being denied but we haven't had an update since then. I think Dr. Sclafani had stated not long ago his patients had coverage with Medicare. I wonder if coding is the difference. If coding is not the difference I wonder why New York is different then Mpls. on coverage when it comes to Medicare. Does anyone know?


It isn't a matter of medical billing codes. Dr. Makris' billing office didn't put the procedure down as being a treatment for "MS" rather as treating venous disorders (which, BTW is exactly what was done). I saw the codes they successfully used; nowhere was "MS" mentioned.

Medicare did pay for my three previous procedures, done by three different Interventional Radiologists. They finally paid for my last follow-up ultrasound test.

What is different now is the categorical denial of coverage for any future treatment. My guess is that the initial CCSVI treatments were "under their radar" but now are reaching sufficient caseloads that they became aware. What is very worrisome is that many private medical insurance policies follow Medicare's determinations so if they consider CCSVI procedures as "experimental" the co-insurers will do also.

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Re: Medicare Denial For CCSVI Treatment!

Postby 1eye » Fri Sep 30, 2011 5:05 pm

Now here is where semantics is important. Are we going to see it become the procedure that is done in back alleys like abortion used to be? Are "MS" diagnoses really a tattoo given to an underclass of people whose existence is an embarrassment to right-thinking professionals? Will it only be done now by activist humanitarians? Or doctors to the stars?
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Re: Medicare Denial For CCSVI Treatment!

Postby Cece » Fri Sep 30, 2011 7:30 pm

Thanks for the update on Medicare, although I wish it were better news. Now we need a few randomized controlled studies to go our way.

I really object to the BCBS policy that stated this is CCSVI treatment for MS. What I received was CCSVI treatment for CCSVI. I had improved color vision before I left the OR, at the end of my first procedure. MS is a condition of inflammation and damaged nerves; it's not like those healed suddenly that afternoon. What was healed was the blood flow. My symptoms had been grouped as MS symptoms. But they turned out to be CCSVI syndrome symptoms instead.

1eye, yeah, if I knew someone who was being investigated for MS, I would strongly advise that they first get tested for CCSVI before they get the diagnosis of MS. There was no mention of MS on some claims that have been denied, which means that the insurance company is looking elsewhere in the patient's records for that diagnosis and using that to deny the claims.

Donnchadh, will you pay out-of-pocket for an ultrasound, or have you been doing well enough that you're not worried about restenosis?
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Re: Medicare Denial For CCSVI Treatment!

Postby Donnchadh » Fri Sep 30, 2011 8:20 pm

Cece wrote:Thanks for the update on Medicare, although I wish it were better news. Now we need a few randomized controlled studies to go our way.

I really object to the BCBS policy that stated this is CCSVI treatment for MS. What I received was CCSVI treatment for CCSVI. I had improved color vision before I left the OR, at the end of my first procedure. MS is a condition of inflammation and damaged nerves; it's not like those healed suddenly that afternoon. What was healed was the blood flow. My symptoms had been grouped as MS symptoms. But they turned out to be CCSVI syndrome symptoms instead.

1eye, yeah, if I knew someone who was being investigated for MS, I would strongly advise that they first get tested for CCSVI before they get the diagnosis of MS. There was no mention of MS on some claims that have been denied, which means that the insurance company is looking elsewhere in the patient's records for that diagnosis and using that to deny the claims.

Donnchadh, will you pay out-of-pocket for an ultrasound, or have you been doing well enough that you're not worried about restenosis?


Because I am on a modest disability pension, I cannot afford to pay the cash price for the follow-up ultrasound. My improvements seem to be continuing and stable. However because the problems at the sigmoid sinus were not treated, I am far from being completely normal. I can only hope that some day Medicare will reverse their decision about CCSVI procedures.

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Re: Medicare Denial For CCSVI Treatment!

Postby CD » Fri Sep 30, 2011 10:11 pm

I think Medicare doesn't pay for any new drug that the FDA approves until it is on the market about one to two years. They deem new drugs experimental too.

Yet do they pay for all the DMD's now, or not the new ones?

Remember when they only paid if the doctor injected you with Avonex in his office when it first came out?. Then people got mad because Diabetes patients could inject at home.

Time may change how things are handled, unless the new health care plans for 2012 limit us on our drugs and procedure/ treatments.
It is so disconcerting, to say the least. :?
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Re: Medicare Denial For CCSVI Treatment!

Postby Donnchadh » Sat Oct 01, 2011 6:10 am

I am curious to find out if the private medical insurance carriers will now follow Medicare's lead and also deny coverage? If yes, this would have the result of having CCSVI treatments come to a screeching halt, as only whose who can afford cash self-pay or included in a funded research project would be treated.

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Re: Medicare Denial For CCSVI Treatment!

Postby pklittle » Sat Oct 01, 2011 7:21 am

The diagnosis code for Multiple Sclerosis is 340. What is the diagnosis code for CCSVI?
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Re: Medicare Denial For CCSVI Treatment!

Postby Cece » Sat Oct 01, 2011 7:22 am

Donnchadh wrote:I am curious to find out if the private medical insurance carriers will now follow Medicare's lead and also deny coverage? If yes, this would have the result of having CCSVI treatments come to a screeching halt, as only whose who can afford cash self-pay or included in a funded research project would be treated.

Donnchadh

BCBS has been denying in some states for awhile now. But not in others.

If nothing else, I think they should stick to the standard of covering it if a blood vessel is stenosed 50% or more. This is what was originally said here at TiMS back in 2009 as standard insurance policy. It doesn't make sense to me for insurance to cover the treatment of a blocked jugular if it's a renal dialysis catheter-related blockage or a thrombosis but not if it's a valve malformation.

I am not sure how long I can expect my jugulars to stay open. My right jugular is at almost 8 months now since ballooning, my left jugular is at 2 1/2 months. So the insurance issue may eventually get me, if my insurance begins issuing denials and if I restenose to the extent of needing retreatment. Both seem quite possible, frankly!

I have little doubt that Medicare will eventually reverse this decision, because I have little doubt that the research will bear out the benefits of CCSVI treatment, barring any really unexpected results.
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Re: Medicare Denial For CCSVI Treatment!

Postby Cece » Sat Oct 01, 2011 7:27 am

pklittle wrote:The diagnosis code for Multiple Sclerosis is 340. What is the diagnosis code for CCSVI?

Aren't they in the process of switching from ICD-9 to ICD-10, and the new one has very precise codes for treatments in each vein (azygous, jugular, etc)?

ICD-9 459.81 is venous insufficiency, unspecified. Or there's 459.2, venous compression, which is the one that Dr. Cumming's office saw getting denied by Medicare last spring.
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Re: Medicare Denial For CCSVI Treatment!

Postby 1eye » Sat Oct 01, 2011 12:13 pm

:sad:
There was no mention of MS on some claims that have been denied, which means that the insurance company is looking elsewhere in the patient's records for that diagnosis and using that to deny the claims.

Sorry I feel I have to reply on this very upsetting thread. After all, I am a naturalized Canadian. I have never, however, renounced my American citizenship, having been born in Detroit. I feel like I am living on time-with-two-mortgages (where does that word come from?), but never mind. My country has taken in refugees a long time, including former slaves, and to a certain extent, my family (from McCarthy, not the draft). Again, never mind.

I think this practice is criminal and violates the right to privacy along with many other reasons for being wrong. After all, "MS" patients have a free ride as far as taxes go, right? We are so much more civilized here, not even allowing the procedure to take place... :sad:

I thought I heard somebody with a certain well-known mother-in-law say "yes we can".

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Advice to people taking care of people with "MS"/CCSVI: Cultivate an appreciation of the sardonic, and ironic, pleasures in life. :smile:
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Re: Medicare Denial For CCSVI Treatment!

Postby Donnchadh » Mon Dec 19, 2011 10:30 am

Anyone have recent experience with Medicare coverage or denial of their treatments????

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