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Aetna
Posted: Sun May 08, 2011 7:39 am
by WeWillBeatMS
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."
WeWillBeatMS
Posted: Sun May 08, 2011 7:55 am
by Cece
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.
Posted: Sun May 08, 2011 7:51 pm
by drsclafani
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
Posted: Sun May 08, 2011 8:44 pm
by Cece
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.
Posted: Mon May 09, 2011 8:06 am
by WeWillBeatMS
Dr. Sclafani,
Would you consider the azygos & the 4 jugulars "major" veins?
WeWillBeatMS
Posted: Wed Jun 08, 2011 9:46 am
by cathyb
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!
Posted: Wed Jun 08, 2011 12:12 pm
by WeWillBeatMS
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!
WeWillBeatMS
Posted: Wed Jun 08, 2011 1:04 pm
by 1eye
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.
Re: Aetna
Posted: Fri Aug 24, 2012 2:41 pm
by Cece
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.
Re: Aetna
Posted: Sat Aug 25, 2012 3:39 am
by CureIous
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
Mark
Re: Aetna
Posted: Sat Aug 25, 2012 12:35 pm
by Cece
Thanks, that's encouraging that Aetna is covering the procedure for her. Hope she sees results.
Re: Aetna
Posted: Sat Aug 25, 2012 2:48 pm
by CureIous
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.
Re: Aetna
Posted: Sat Aug 25, 2012 10:59 pm
by Cece
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.
Re: Aetna
Posted: Sun Aug 26, 2012 1:19 am
by 1eye
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?