Has insurance paid for anyone?

Crystwo · Post by **Crystwo** » Mon Jan 03, 2011 1:19 pm

Has anyone had their insurance pay for their CCSVI procedure? I have BCBS of MN (although live now in CA), and had my procedure done last Thursday...WOW!! I'd recommend it to anyone whether insurance pays or not...however, has anyone? I will submit codes, CD, paperwork and a letter this week. Was just wondering what to expect.

BTW, lurking for about a year now, all you guys are wonderful. The procedure (Pacific Interventionalists, in New Port Beach CA, $8000) was totally awesome. So glad I had it done. See differences already

CaptBoo · Post by **CaptBoo** » Mon Jan 03, 2011 1:27 pm

BCBS/NM paid for mine. Atlanta Access Care billed them $20,000, my portion was $1,900. AAC had the procedure pre-approved. I'm still trying to get reimbursed for the doppler ultrasound. CCSVI-Atlanta does not take insurance so I had to send it in. Over a month, no reply.

Crystwo · Post by **Crystwo** » Mon Jan 03, 2011 1:35 pm

Thanks for that info. I wonder when this will be the norm for all of us...business-wise, you'd think insurance would INSIST everyone diagnosed with MS have this first...alot cheaper than paying for 1000's of us to be taking expensive drugs (that don't work) for the rest of our lives!

CaptBoo · Post by **CaptBoo** » Mon Jan 03, 2011 1:42 pm

But here's the rub, at least in my case. BC/BS is not my drug insurer, so they don't care what drugs I need. And since I gave up on the drugs and the doctors that prescribe them, my MS wasn't costing BC/BS anything. If I'd had to fight it, that would have been my argument, neuro visit with blood tests every six months and brain and spine MRI every year. The bill from Mayo Clinic a couple of years ago when I last did that was close to $20,000. If BC/BS was my drug provider, the argument would be even stronger.

CD · Post by CD » Mon Jan 03, 2011 1:45 pm

I paid for mine. I have ins, but it does not cover New York. Since I went to Albany, NY I paid. I will send in the bills to my ins as out-of-network.

Anyway, I will put this all on my income tax, as I itemize. Of course they say the US Federal Gov. will not have the income tax forms/figures for those that itemize until February.

If you send in earlier you pay a higher rate. If you use the standard deduction you can send in earlier they said. Check out the Federal income tax site to be sure.

I think I have more write-offs than income this year. Hmm

Crystwo · Post by **Crystwo** » Mon Jan 03, 2011 2:01 pm

So Captboo, maybe I should threaten BCBS that I'll go BACK on Tysabri for life if they refuse to pay the measly 8 grand!! Maybe that's what all of courses of action should be!

CaptBoo · Post by **CaptBoo** » Mon Jan 03, 2011 2:13 pm

And also mention the cost of treating PML.

msgator · Post by **msgator** » Tue Jan 04, 2011 9:22 am

I had my procedure done in RI and insurance covered it. I paid $776 out of pocket because I have a co-insurance plan which means smaller premiums but higher percentages. Oh and $35 for the lovanox and $7 for the Plavix.

brave · Post by **brave** » Tue Jan 04, 2011 9:40 am

I had my procedure done in Albany, living in CA and insurance covered it. My part is $100 which I haven't recieved the bill yet.

brave

davmets2 · Post by **davmets2** » Tue Jan 04, 2011 10:38 am

I live in Albany, NY and work for the state. My insurance is United Health Care. They preapproved the procedure that I'm gonna be having next Monday (1/10) with Dr. Mehta of the Vascular Group. He requires two procedures, so I guess that's what my insurance will be picking up. There's normaly a copay of $20 per test or office visit. Whatever this procedure copay amounts to, I'm sure it won't be much.

soapdiva884 · Post by **soapdiva884** » Tue Jan 04, 2011 11:21 am

We live in Upstate NY about 3 hours from Dr. Sclafani and our insurance did NOT pay! They would not pay out of network, so it came out of the retirement fund

We did everything possible from having Johns General Practitioner submit to having the neuro submit to no avail! However, we believe the f/u u/s will be covered now that it is determined John has ccsvi and no one around here treats that. We shall see!
$10,000.00 plus food-hotel-gas was completely worth it in the end though!
Oh and 5 days of dog boarding too!

Crystwo · Post by **Crystwo** » Tue Jan 04, 2011 12:54 pm

Thanks everyone...Soapdiva, keep trying. Our insurance has been great so far so anticipate them paying. I have heard the the words "MS" should not be mentioned anywhere. We are just having a procedure to clear up malforming valves and restore proper circulation.