Innsurance for CCSVI operation

[bmk1234]

bump

[bigfoot14]

Hi jak7ham9

I use Federated Insurance - Preferred One. Any help would be appreciated. Also, I have had a headache everyday for the last 8 years or so, sometimes very severe. Would this give me another alternative to possibly getting it paid for by insurance, headaches vs. MS? Thanks for your help.

I remember reading in another thread that some one used constant migraines as a reason to get tested/treated, they never mentioned the MS to the insurance co ........I believe it was one of Dr Dakes patients

good luck

[grace4et]

hello. i have ghi cbp through nyc and this dr sclafani advised me yesterday that insurance does not pay. please help.

[Cece]

welcome to TiMS, grace4et.
just so no one else is confused this is a two-year-old thread. I'm not sure what's in the thread but it is likely out-of-date.

If you are set on Dr. Sclafani as your doctor, then the only option would be to pay out-of-pocket. I was treated by Dr. Sclafani and it was a very positive experience.

If you are open to considering other doctors, then you could call around and see if one of the other doctors will take your insurance. Different clinics have different policies. The FDA alert this spring may have made some clinics more cautious. If they accept insurance and then three months from now, the insurance company turns down claims, then the clinic either has to forgive the bill or come after the patients to collect. When Medicare started denying the procedure after over a year of paying for the procedure, the clinics were not able to come after the patients because of Medicare rules. It's up to each provider whether to accept insurance for the procedure at this time or not. My procedures were paid for by insurance but that was over a year ago.

Even if the procedure is preapproved, it could be denied when the claim is processed months later. Blue Cross Blue Shield caused some patients some trouble this way about a year ago. Just as an example here is the Blue Cross Blue Shield statement that (wrongly) calls venoplasty for CCSVI investigational: http://www.empireblue.com/medicalpolici ... 136297.htm
If it's investigational, they won't cover it. Not all insurance companies have a policy in place like this yet but it may be the direction we are headed.

I am trying to think of other doctors in NY: Dr. Siskin in Albany; Dr. Sperling at Columbia; Vascular Access Centers which might be NJ; ??
It's my opinion that doctor selection is one of the biggest choices we make (immediately following the choice to get the procedure done) so make sure you find out what you can about whatever doctor will take your insurance. You want to be comfortable with the doctor's level of experience specifically doing the CCSVI procedure, and you want to be in agreement about how conservative or aggressive and how precise or imprecise the doctor will be with his techniques.

Good luck, it isn't easy, but there might still be an opportunity to get this covered under insurance from a different clinic. If you have to travel, please make sure you have plans in place for local follow-up care if needed.

[Cece]

Dr Siskin's list of insurances accepted

Insurance Accepted

While we accept most major health insurance plans, it is important to confirm whether the specific services you require are covered by your health insurance at the time you schedule your appointment.

Our staff will gladly answer all of your questions — please feel free to call our office during regular business hours.
Access Health
Aetna/US Healthcare
American Progressive
Beacon/Universal/RMSCO/Preferred Care/Excellus
Beech Street (including FiServ & OptiMed)
Blue Shield NENY
CIGNA (through MVP or PHCS only)
CDPHP (for Medicaid, please consult your provider's office)
Empire Blue Cross •Empire Medicare Advantage Plan
•Anthem Blue Cross Medicare Advantage Plan

Fidelis Care New York •Medicare Advantage Plan
•Fidelis Medicare
•Fidelis Medicaid
•Fidelis Duel Eligible

Galaxy Health Network
GHI HMO & PPO
Magnacare (Radiology only)
Martin's Point (please verify when scheduling your appointment)
Medicaid (please verify when scheduling your appointment)
Medicare •Medicare Advantage (please verify coverage when scheduling your appointment)

Metra Comp/Focus
MVP •MVP Gold (Medicare Advantage — please confirm with provider)

NOVA Healthcare Administrators
NYMI (please verify when scheduling your appointment)
NYS Empire Plan
Private Healthcare Systems (PHCS/Multiplan) •Cigna PHCS Connecticut General Life Ins. Co. (please verify coverage when scheduling your appointment)

RR Medicare
Senior Whole Health
Shared Health Network
Statewide Independent PPO, Inc.
United Healthcare
Today's Option (please verify when scheduling your appointment)
Tricare Prime (all plans) •Tricare Champus

http://www.communitycare.com/practices/ ... cepted.asp
Dr Siskin has been involved in CCSVI from the beginning in 2010. He has done hundreds of procedures. He has published and he is running a separate randomized controlled trial. I do not believe he uses IVUS and I am not sure what anticoagulant he is prescribing these days. He has several partners so it might be Dr. Mandato or Dr Englander that you would be treated by if you went with his clinic. There is usually a really long waiting list for self-paying patients (into spring 2013) but a shorter waiting list for insured patients since they can be treated at the hospital. Even so it might be longer than the waiting list at any other provider.

[grace4et]

thaks alot for the info! i really wish i could find a dr more local as im in brooklyn ny and its over 3 hrs away but in the meantime im gonna give this clinic a call and see what they may can do for me.;)

[Cece]

I have spent the last 2 1/2 years gathering info on CCSVI.

At the risk of overwhelming you with information, let me add that I think Siskin is a good choice. Concerns would be that he does not use intravascular ultrasound, he does not check the renal vein which in some patients may be blocked and diverting blood flow into the cerebrospinal veins, and he may or may not always prescribe a true anticoagulant.

If any of these concerns are important to you, there are other doctors who do these things. Dr. Cumming in MN and Dr. Arata in CA are the only US doctors, in addition to Dr. Sclafani, who use intravascular ultrasound in every patient. Dr. McGuckin treats the renal vein. I think Dr. McGuckin is in NJ although he is confusing because he had treated patients at different VAC clinics throughout the country. If proximity to Brooklyn and acceptance of your insurance are the top criteria, Dr. Siskin is still the first one that comes to mind with the bonus being his experience with the procedure.

Let us know how it goes! I get nervous for people because we sometimes hear back an amazing wow story (yeah tilt I'm talking about you) and sometimes no improvements and there's no predicting what group anyone will fall into ahead of time. The latest figure that's been tossed around is 70% of patients get mild to moderate improvements, and 30% get no improvements. I of course would have it be 100% wow improvements for everyone.

[drsclafani]

Dr Siskin's list of insurances accepted

Insurance Accepted

While we accept most major health insurance plans, it is important to confirm whether the specific services you require are covered by your health insurance at the time you schedule your appointment.

Our staff will gladly answer all of your questions — please feel free to call our office during regular business hours.
Access Health
Aetna/US Healthcare
American Progressive
Beacon/Universal/RMSCO/Preferred Care/Excellus
Beech Street (including FiServ & OptiMed)
Blue Shield NENY
CIGNA (through MVP or PHCS only)
CDPHP (for Medicaid, please consult your provider's office)
Empire Blue Cross •Empire Medicare Advantage Plan
•Anthem Blue Cross Medicare Advantage Plan

Fidelis Care New York •Medicare Advantage Plan
•Fidelis Medicare
•Fidelis Medicaid
•Fidelis Duel Eligible

Galaxy Health Network
GHI HMO & PPO
Magnacare (Radiology only)
Martin's Point (please verify when scheduling your appointment)
Medicaid (please verify when scheduling your appointment)
Medicare •Medicare Advantage (please verify coverage when scheduling your appointment)

Metra Comp/Focus
MVP •MVP Gold (Medicare Advantage — please confirm with provider)

NOVA Healthcare Administrators
NYMI (please verify when scheduling your appointment)
NYS Empire Plan
Private Healthcare Systems (PHCS/Multiplan) •Cigna PHCS Connecticut General Life Ins. Co. (please verify coverage when scheduling your appointment)

RR Medicare
Senior Whole Health
Shared Health Network
Statewide Independent PPO, Inc.
United Healthcare
Today's Option (please verify when scheduling your appointment)
Tricare Prime (all plans) •Tricare Champus

http://www.communitycare.com/practices/ ... cepted.asp
Dr Siskin has been involved in CCSVI from the beginning in 2010. He has done hundreds of procedures. He has published and he is running a separate randomized controlled trial. I do not believe he uses IVUS and I am not sure what anticoagulant he is prescribing these days. He has several partners so it might be Dr. Mandato or Dr Englander that you would be treated by if you went with his clinic. There is usually a really long waiting list for self-paying patients (into spring 2013) but a shorter waiting list for insured patients since they can be treated at the hospital. Even so it might be longer than the waiting list at any other provider.

Please be careful. The listing that Cece adds here is for all the insurance careers that are accepted. However many of them do not reimburse for CCSVI. Medicare clearly does not, nor does blue cross blue shield.

at their site states: "While we accept most major health insurance plans, it is important to confirm whether the specific services you require are covered by your health insurance at the time you schedule your appointment."

[grace4et]

thanks cece for the info and link, it's a start you know! thanks dr sclafani for posting that info for me again and also im a little confused about things because i found your name on the ghi's find a doctor feature and thought that meant you were an in network dr for me because i did this using my id# but guess i was off track with that one but im kind of hesitant to call them and ask if they will cover this procedure because i dont know if i should ask for a specific code or something or just what i should and should not mention....but thanks alot once again

[CureIous]

Still have all my follow ups, scans MRI's, US, covered by my insurance, at 10k nothing to sneeze at, I'm in the BC/BS network. Your mileage may vary.

[drsclafani]

Still have all my follow ups, scans MRI's, US, covered by my insurance, at 10k nothing to sneeze at, I'm in the BC/BS network. Your mileage may vary.

Great. Let's hope you don't need another procedure