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Insurance Not Covering Autonomic Testing Anymore?


Anoj

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This is definitely a very disturbing development. It's hard enough for patients to get to a doctor who knows something about our condition but then to not have insurance cover it once they find a provider is just ridiculous.

I know DINET has a policy against "soliciting" on this forum, but I hope they will allow this thread to remain as it is critical to the well-being of all Dysautonomia patients. If we don't have insurance coverage, we won't have doctors who can get paid to see us therefore no one to do research and thereby no help for us. This is something that we really need to be informed about and the forum is one of the few means we have to communicate something of this magnitude.

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Hello,

Just returned from the Mayo Clinic in October and so far 3 of the tests I had done have been denied by my insurance as being experimental. I never had problems before so now I realize why. I am going through the appeal process. I wish the people making these decisions could spend one day in my shoes.

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i am definitely not soliciting anything. i'm not affiliated with the organization. however, i don't see the harm in dysautonomia patients fighting to keep insurance coverage for testing. or at least being aware that this is happening. although i doubt writing letters to wellpoint's execs would make a bit of difference.

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Hello,

Just returned from the Mayo Clinic in October and so far 3 of the tests I had done have been denied by my insurance as being experimental. I never had problems before so now I realize why. I am going through the appeal process. I wish the people making these decisions could spend one day in my shoes.

:( that's terrible. i hope you get it sorted.

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I have blue cross/blue shield also. I have been fighting for a year for them to pay for my tilt table test. They denied it because they said it was not medically needed since I don't faint. I am hyper pots so I don't faint instead get hypertension crisis symptoms. Of course u can't talk personally to the board just customer assistants. My doc wrote a letter and said to call if they needed to talk to her, but they denied without calling. I think they hope people give up and just pay it, well I am not! Oh and the test showed that I am a crazy mess, so how can that not prove it was needed!

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Joann, I know that's so frustrating to fight with an insurance company over coverage - it really does seem like they just try to wear you down til you stop pursuing it. I know this won't help you on this test, but it's a tip for the future to make things easier with insurance - during every appointment/test/etc. doctors have to assign an ICD code for your diagnosis. Since there's no specific code for POTS, they have to choose how to code it. Mine usually pick a couple, but one I've seen consistently is "Syncope/collapse". I've never fainted either but I guess technically we all could! I asked a doctor about it once and he specifically said he did it for insurance purposes - insurance looks at these codes to decide what sort of testing is justified. The next time your doctor orders a big test or something, check with them on how your diagnosis is coded. Most doctors are really helpful about trying to get insurance to cover to whatever testing they think you need.

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  • 4 weeks later...

Here's a link to the five biggest insurance companies. http://pharmacy.about.com/od/Insurance/a/The-Big-Five-Health-Insurance-Companies.htm

Wellpoint is the company that is denying autonomic testing. But Wellpoint is (pasting):

ellPoint's plans do business as Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Georgia, Empire Blue Cross Blue Shield, or Empire Blue Cross (in the New York service areas). WellPoint also serves customers throughout the country as UniCare.

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  • 3 weeks later...

I work as a cardiology coder in one of the top POTS hospitals, and even with my company insurance, it took nine months to get my TTT approved. :wacko: The problem was my cardiologist was using 785.0 for tachycardia, which will not work on a claim. He told me that he had never been successful in getting any employee a TTT. My neurologist, on the other hand, did get the TTT approved by my insurance, he used 337.9 which is for unspecified autonomic dysfunction. When I next saw my cardiologist, he asked how the heck I managed to get the test approved and I told him. He was pretty dumbfounded, haha.

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I have blue cross blue shield. They are denying my IVIG and plasmapheresis treatments. This getting real fun. I am appealing and trying to get the procedures re coded.

Most insurance companies only approve IVIG and/or plasmapheresis for a certain diagnosis (POTS is NOT one of them on the list)

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I still have 180k I am appealing..... The amount is so large I can't say I am too concerned. If I have to pay I'll send them $50 a month for the rest of my life LOL. MY main issue is my Doctors office/Hospital should have know I'd face this issue ahead of time.

So sorry! I know it's frustrating. There are so many insurance companies and varying policies that there is no way a Dr's office or hospital could keep up with all the various policies. Even within an insurance company there can be many different policies with different rules and coverages. It is always up to the patient (at least here in the U.S.) to contact the insurance company to find out what will or won't be covered. Dr's offices CAN sometimes help in the appeals process though. One thing that might help in your appeal is to include any medical journal articles that support the use of the procedures you had for patients with your diagnosis. You really have to build your own case which is sad because most of the time people are sick and don't have the energy to fight the companies the way they need to be fought with.

Best of luck to you!

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  • 1 year later...

I know I posted this a long time ago, but does anyone know if these things are still being denied?

I am interested (again) in pursuing additional doctors and/or clinics, including possibly Vanderbilt, but I'm not willing to do this if it's going to cost me tens of thousands of dollars.

I'm actually trying to be proactive about building more medical records for myself in case I have to ever file for disability. I consider this often. My current cardiologist isn't much help, as he acts like this is all my fault because of "deconditioning," and I don't think that makes a very strong case.

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Does anyone know if this affecting Federal Insurance companies like Tricare? Though I was able to get IVIG approved last October since the initial dose have been unable to get further treatment approved. Such a shame because it was/is really helping me.

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  • 9 months later...

My cardiologist at UCLA just tried to get a pre-authorization for a tilt table test and it was denied by Blue Cross Blue Shield of Illinois. The basis of their denial is that I haven't actually fainted. I have had a previous TTT in 2011 at the Mayo Clinic in Arizona that resulted in the diagnosis of POTS.  I have an atypical presentation, with my blood pressure bouncing up and down during the test. The purpose of the retest is to see how well the beta-blocker I am on is working. I plan to appeal and was wondering if anyone else has  done so and had any suggestions for me. Specifically, I'm looking for help with recommended verbiage and medical literature citations. 

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  • 2 months later...
On 11/21/2013 at 10:52 PM, Anoj said:

http://www.dysautonomiainternational.org/page.php?ID=166

Is this true? I have already send my protest emails. (Not that it would do much.)

Hi there, I am new to this site and so I am just getting around to seeing people post. I am so sorry that you are going through this with insurance....You know when I got very sick last year and my BP dropped to 86/60 I almost fell in the shower....I went to the ER and they put me in the hosptial. When my cardiologist came in I looked at her and said I cant take this anymore and I amnot leaving until they figure out why my BP is so low and I cant get up without feeling like I am going to fall....I told the electrophysiology doctor the same thing and I got my tilt table test and EP study done in the hosptial and everything got covered. I was tired of livign like that going to doctors that make you go to more doctors and I am glad that I put my foot down and now we know I have POTS, Lupus, another autoimmune disorder...if you get bad go to teh hosptial then demand they do it there.

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