This Is MS Multiple Sclerosis Knowledge & Support Community

I had the procedure done in Chicago in March and was denied coverage from my insurance company. I was wondering if someone out there had there procedure covered by insurance and if the doctors office filed the claim. My procedure was filed by AAC. I would think they would know how to work the insurance company to get it covered, but that was not the case. I am worried that if I have to go for another procedure where the money will come from. Any help is appreciated.

Do you know how to go about doing an appeal? I think it's worth trying. Was your insurance BCBS?

My insurance was filed by AAC in Brooklyn in July, and it went through without any issue.

Are your worries about another procedure more future-based or do you feel like you may have restenosed?

I have insurance with my employer. I am just thinking into the future. I would hope that I would not have to deal with re-stenosing anytime soon. It would be nice if this was widely accepted by all insurance companies, that is what we pay the premiums for, so I thought.

anamishguy wrote:I have insurance with my employer. I am just thinking into the future. I would hope that I would not have to deal with re-stenosing anytime soon. It would be nice if this was widely accepted by all insurance companies, that is what we pay the premiums for, so I thought.

When I was diagnosed, I spent 2 nights in the hospital. This stay was preapproved with my insurance company by my doctor's office otherwise it never would have happened. In spite of the preapproval, the insurance company still tried to deny coverage for the hospital stay after the fact. I took their denial letter back to my doctor's office and they took care of the issue with the insurance company. It was perhaps fortunate that I had the weight of a university medical system standing with me against the insurance company.

NHE

I had a veinogram and angioplasty done at Albany Medical center in October 2010 for CCSVI.
My insurance refused to pay because they said it was not an approved treatment for MS.

I did a written appeal and stated;
I AGREE IT IS NOT AN APPROVED TREATMENT FOR MS.
SHOW ME WHERE IN MY POLICY DOES IT STATE THAT IF YOU HAVE MS, THE POLICY DOES NOT COVER A STANDARD VEINOGRAM AND ANGIOPLASTY TO RESTORE NORMAL BLOOD FLOW FROM MY BRAIN TO MY HEART.

They then agreed to pay.

JERRY

That is excellent! I haven't heard of many people appealing and winning. I know people who aren't getting the procedure because their particular insurance isn't covering it.

This refusal is part of the pattern we have come to be acutely aware of. People who want to prove that something about themselves is important, by using the "MS" patient as a convenient way of flexing their bureaucratic muscles. Insurance companies who find the pigeonhole to be convenient and temporarily profitable as well. "MS" is used as an excuse for all kinds of questionable behaviour. I think many still believe in eugenics. In the early nineteen-sixties, forced sterilization was practiced on people assessed as "morons", by others who had power over them. Even today, universal health care, one of the benefits given most Canadians, is only available if you are a submissive and cooperating patient.

I can understand those who make cranky or annoying people wait longer, say, for emergency-room treatment. They have to limit scarce resources, and it sometimes insulates them from abuse. The discrimination against pw"MS", in contrast, is a reflex reaction, because there is a 150-year record of treatment failure, and because the victims, being dead, are never in a position to argue. Even supreme court judges get into it. Some, I believe, think that the only good solution is birth control. Like some rock song said when I was in high school: "What you gonna do about me?" Too late for abortion or sterilization, by a few decades. Wait it out, if you are in government, or a competing drug vendor. Sometimes I think this must all be just a bad dream, but then I remember.

The bottom line is, bad drainage will make you sick, anywhere in your body, whether you have "MS" or not. It is discrimination.

very well stated rockybear!! too many times and too many ways they use the old excuse that because a person has ms they should not be getting certain medical procedures done. hopefully the air will get cleared soon. this bull that they pull is exactly what it is--bullshit!!

you did good-real good!!

Has anyone had any recent experience with Medicare coverage? Last time I checked, they were denying coverage because it is an "experimental" procedure for MS.

Donnchadh

I know someone who had the procedure done very recently and it's been submitted to Medicare. Would love to see it go through.