Insurance

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

Insurance

Postby frijkaard » Sun Nov 22, 2009 12:02 pm

I am a new member although I have followed the comments on this board for a couple of weeks.
I want to do the procedure with DR. Dake and I have answered all of questions, sent in my insurance info, and sent him photos of my last MRI. Alex e-mailed me said that she has everything and that Dake will be contacting me next via phone. My question is about insurance. I have learned that Dr. Dake sharges $80,000 for the "liberation procedure." How do I get this covered by my insurance? I have blue cross/blue shield of california with a HMO and POS.This procedure is so new, nobody knows about it(least of all the insurance companies) What is best way to go about this? My neurologist and GP have both expressed that will be advocates for me. but how? I would love to hear from anyone who has successfully dealt with this issue and gotten covered.
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Postby Arcee » Sun Nov 22, 2009 12:21 pm

Congratulations on moving forward! I think that most if not all of us who have gone learned to let Dr. Dake's staff take care of this. They have done it many times and know how to deal with insurance, and they will let you know if you should step in directly.
Every insurance company is different, and I remember that someone else had to deal with the same one as you, so maybe they will chime in, or you could search for it, in case they have something specific to add.
diagnosed RR in spring '04
1 stent placed in left jugular vein 7/15/09
on and off Copaxone
allergric to interferons and Tysabri
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Re: Insurance

Postby CureIous » Sun Nov 22, 2009 12:32 pm

I'm Blue Cross Blue Shield of California and had it done through my PPO. Everything down to the janitor at Stanford is in the the BC/BS network. That's the key deal here is "in network". What a relief it was to find that out. My MRI cost me 300 bucks and that was mostly for the IV stuff. 300 bucks for 1.5 HOURS in the tube is a steal at today's prices. They also have financial assistance if needed.

So far my latest bill from my EOB (Explanation of Benefits) from insurance is showing a bunch of zeros that they negotiated but the payout (so far) for the operation/room etc has been 34k. (actual check that was cut), with my balance on that part being 1,713.00. Not sure about the rest of it, guarantee I will be calling for financial assistance since I'm not working right now.

Every insurance is different though so let Alex work her magic and see what happens!

And congratulations too!

:) Mark.
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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Postby cheerleader » Sun Nov 22, 2009 1:28 pm

The CTV doc said that Jeff paid for his procedure...which is not true. His insurance paid, and we were out of pocket about $1,800. Venous stenosis and occlusion is a medical problem, and fixing it is covered by most insurance plans.
cheer
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Postby prof8 » Sun Nov 22, 2009 1:45 pm

I have Blue Cross Blue Shield PPO (not in California). Stanford is listed as "in-network" for me. Actually, I have both a primary and secondary insurance with BCBS. I went to the Mayo Clinic once--it was listed "in network" and I only had my deductible to meet. Thus, I expected not to have any issues with Stanford.

But Alex seems to be having a very difficult time getting approval for this--I don't know exactly what the problems are since I haven't been able to get in touch with her. I am scheduled to go in December. I'm on Dr. Dake's surgery schedule. Hopefully this gets resolved soon. Waiting around not knowing is stressful and exhausting.
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