Insurance Company No Longer Covers Autonomic Testing

[Chaos]

A major insurance company has recently announced that it will no longer cover autonomic testing. We all know how devastating that will be, not only for individual patients, but also for Dysautonomia research in general.

Here is a link to the story. http://www.dysautonomiainternational.org/page.php?ID=166

At the bottom of the story is a sample email if you are so inclined to help protest this kind of decision. You might also want to get your friends and family involved. This company has decided to stop paying for the testing and another one is considering following suite. We do NOT want this to happen. After all the years of being shunted from doctor to doctor trying to get answers, the last thing we need is this!

[Katybug]

Do we know what promoted this change?

[Faintinggoat]

they state that autonomic testing is "considered investigational and not medically necessary for all indications"

[lejones1]

I'm assuming it was just prompted by cost cutting. They give detailed rationale here - http://www.anthem.com/medicalpolicies/policies/mp_pw_c160708.htm. It refers to a couple of studies that found that the tests aren't essential to diagnosis and that testing doesn't necessarily change the treatment plan. It's seems ridiculous - I know that for me, testing did change my treatment plan. I also wouldn't know that I have SFN if I didn't have a QSART test - skin biopsy came back normal. A huge part of the reason that testing doesn't change our treatment is because there isn't much known about the mechanisms of dysautonomia, there are only off-label treatments for us anyway, and they don't always work. That certainly doesn't mean it's pointless.

This is so frustrating! I'm writing them an email - they don't own my insurance company but I think this matters so much to all of us.

[KareBear]

The only test they STILL will cover is the TTT.

[MomtoGiuliana]

I think this statement is pretty key (from http://www.anthem.com/medicalpolicies/policies/mp_pw_c160708.htm)

There is a paucity of evidence documenting how autonomic tests change management or impact treatment in clinical disorders associated with autonomic nervous systems dysfuntion.

I hope someone/institution will do a study to address this question a bit better than it seems they have evidence for now. Seems like it could be helpful for now, for them to receive evidence (from physicians?) that these tests did actually result in a change in management or treatment of ANS dysfunction.

[SeattleRain]

After ACA was enacted my insurance company informed me that: My premium is going to double. My deductible will go from $2,500 to $7,500. My co-insurance will increase by 5%. My co-insurance limit will be raised an additional $2,500. I no longer receive 4 free doctor visits per year. My co-pay will raise by $10. What makes it all worth while is that if I ever get over the anxiety of taking multi-vitamins and graduate to heroin, I can have chemical dependency counseling as well as maternity testing (in the event I have a sex change).

Sarcasm aside, insurance companies are cutting corners on less common problems such as AD because of their enormous cost increases with having to provide additional coverage as well as take on those with pre-existing conditions. To think they're going to bend over and take it is wishful thinking. We will always, always be the one footing the bill in the end. I don't blame the insurance companies for this.

[KareBear]

It did say that if you need the testing you can appeal. Now whether that does any good or not i dont know.

[Chaos]

Yes, it would be nice it they would do more studies to figure out a LOT of things about dysautonomia. However when I was talking to my doc at Mayo at my last visit, he was talking about several studies he wanted to do. He said it's "nearly impossible any more to get any funding for them". If he is having trouble getting funding when the insurance companies are paying to keep his section of neurology open, you can imagine how much harder it will be when they aren't.

Not only insurance companies want to make a profit, but hospitals and clinics need to do the same. If insurance companies stop reimbursing for testing, hospitals will not keep offering the services. Then the docs who are currently performing those tests (and research) are going to be forced to start seeing other types of patients and we will once again be left out in the cold.

TTTs have a fairly significant rate of both false positive and negative results so having other data points (like Qsart, catacholamine tests, etc) help make up a more complete picture. For me, the totality of data helped my doctor determine a treatment plan. It has also probably SAVED my insurance company money in the long run because I'm not running from doctor to doctor, or to the ER, because of my symptoms now that I have had these other tests.

The other point is that by having these centers where more complete testing is being done, you have access to doctors who see more patients with your condition as opposed to just having a TTT at your local hospital and being treated by a doc who has never heard of POTS or maybe has read an "Up to Date" article on it. That helps them with their research as well as helping the patients who benefit from their specialized knowledge.