Lew on reflection I remember that Cheer posted that if they find a stenosis in a central vein like the azygos it has to be repaired because it is attached to so many vital organs you can't leave it damaged like that according to her doc comments.
Maybe that would mean that once a person paid for dopplers out of pocket and proved something was amiss they'd HAVE To cover repairs? I do not know for sure it might be a very individual thing.....
both for the doctor involved and for the insurance.
but gosh how much more of these papers etc before it is all but the facts of life? I mean if we get another two papers showing that 100% of MSers have these venous abnormalities before next winter when Dr Zamboni's team releases their results and if the results are good, does it seem to you guys it would be pretty hard for insurers to deny? It seems to me like it might get there by then...
about 10 years ago a guy wanted an ASCT for his MS and he took his story to the news as his insurance had denied it, but once they were on the evening news as Creepezoid insurance they relented and paid for the procedure. That was a long long time before they even had many studies at all; it was very experiemntal at that point. I think of that often and wonder if people will be able to just make the case based on the available research as that man did and win through.
As an additional coverge story, apparently Johns Hopkins is getting insurance to cover hicy even though it is unproven too, so that again suggests enough evidence may be enough if the patient is pushing for it.
Last spring when I talked to JH and they said medicare was covering and insurance would cover in pre approval if they, JH, offered the available resarch on it, jh had published work on 29 patients. I asked Carrie Treker about the numbers of patients and she confirmed it had been very small. They had had some other supportive research to add to it, but not enough to call it proven. and they had NOT treated anything close to 100 people.
The advantage that hicy idea has is that it is the "generally accepted" hypothesis about MS: we all "know" MS is autoimmune, and we are already treating people for that, so it is not a leap to go to hicy.
Assuming success of the liberation 100--doesn't tath sound cool "The Liberation 100" Wobbly that's you!!-- it seems like this should be covered but I'm talking out my ear I don't know, specualting for fun.
This is a blerb out of a site on medicare reimbursement--I chose carotid endarterectomy as it might be similar cost wise to what we'd need because it is a repair of one artery with a stent
On March 18, 2005, the Centers for Medicare and Medicaid Services (CMS) will determine whether to cover carotid stenting. 1 Under the terms of a proposal that CMS issued on December 17, 2004, 2 carotid stenting would be covered for symptomatic patients with stenosis of 70% or more who are high-risk candidates for carotid endarterectomy. Only stenting systems with embolic protection devices could be used in procedures eligible for reimbursement. Reimbursement rates will vary based on the usual CMS adjustments, but the national average might be roughly $1,100 for physicians and $5,200 to $8,200 for facilities. 3
In order to obtain reimbursement, providers will have to demonstrate competence in performing the procedure, evaluating patients, and providing follow-up care. The mechanisms that would be used to determine competence for physicians and facilities have not been specified, so medical specialty societies are expected to propose guidelines and/or plans for the necessary programs
from here
http://www.imagingeconomics.com/issues/ ... -03_14.asp
You can see coverage is a little bit picky--people don't just always get paid in this case there has to be a 70% blockage or no dough.
The good thing, as much as I hate to say it, is that it is an amount I can imagine coughing up personally should it be in that same range. that figure was from 2005 so not the same today though.
The venogram itself is likely a separate charge and likely pretty substantial itself, I can imagine at least a couple grand.
But a final good thing: at that price, considering the cost of stem cell transplants ---geez even copaxone at 25 thousand a year!-- it looks like a bargain for the insurance company.
I'll take two...........