 |
 |
Don et al. PD surgeries generally covered by insurance include palidotomy and Thalamic DBS. Thalamic DBS was approved by the FDA about 1 year ago. It uses the same stimulator device as STN and pallidal stimulation both of which are newer. Pallidal stimulation is similar to a pallidotomy except it is not permanent and cannot be adjusted. STN however appears to be superior to either except it still needs to be validated. My STN surgery was paid for by my medical insurance. There were several factors involved. I was in a wheelchair I had tried virtually everything else except pallidotomy. 2 neurologists wrote that I needed the procedure and nothing else would work and MEDICARE pays for the procedure under the conditions that it is done by an experimental neurosurgeon. The issue is the insurance payment not whether it can be done. Also I might add that I had a professional relationship MEDICAL DIRECTOR of the HMO prior to the surgery request. While I don't think that was the deciding factor it certainly didn't hurt. The more personal the request is the harder it is to turn down. If anyone wants a copy of my letter I would be happy to give it to them. The first thing however is the letter from the neurologist requesting the procedure and certifying that it is the only thing left for you or so superior to a less drastic procedure that it is necessary. Also it doesn't hurt to enclose the NEJM study and others which justify the use of the procedure. Marty- yes it was done at Rush Who is your doctor there? Thanks for all the good wishes and prayers. They have been answered. Don Coplin & Glenna McK Coplin wrote: > Dear "LIST": > > We are much confused. > 1. What PD surgeries are there which are covered by insurance; > 2. Which are not yet approved in the US and when will they be approved; > 3. And are some of these "not yet approved" surgeries being received by some patients in > the US now somehow??) > 4. Are there certain key words or key factors or "magic methodologies" we should know in > getting insurance approvals for PD surgeries? We'd assume if the surgery was recommended by > our insurance approved neurologist that the surgery payment approvals would be "automatic". > > Camilla has helpfully shown me how to access the PD List Archives but I would like to hear > from some of you who have experiences or knowledge pertaining to our above questions since > we're on an 11 day countdown to going to the states for the pallidotomy we requested and our > neuro agreed to without mentioning these other surgeries as also available. > > Thanks! glenna > > "Charles T. Meyer, M.D." wrote: > > > Ruth, You need to see it to believe it. I will be happy to share with you what I > > wrote to get my approval. Jane's bilateral implant should be paid for by > > insurance this time around especially if it is a thalamic implant. Also you need > > not worry about subthalamic implants after the first one It is almost certain > > that it will be approved by that time. STN works and needs to be approved for > > general use. > > > > Charlie > > > > ".Joan Waterman" wrote: > > > > > Yes, welcome to Dennis and also to you, Dr. Meyer. I have been waiting to > > > hear from you and to know that while things are not up to par yet, you feel > > > that it's going OK. My communications with FDA and Medtronics are still on > > > going, but not much accomplished. To add to the mix of problems is that Jane > > > Ross, one of our members who had the bilateral implant 3 years ago and was > > > doing beautifully, had the battery give out and she says it will take another > > > $12,000 to get a replacement! I don't think any of us could handle that > > > every 3 years! > > > > > > Just when I was giving the Stimulator implant my best hope! Here's hoping we > > > find solutions soon! > > > > > > Ruth Clark > > > > -- > > ****************************************************************************************** > > > > Charles T. Meyer, M.D. > > Middleton (Madison), Wisconsin > > [log in to unmask] > > ****************************************************************************************** -- ****************************************************************************************** Charles T. Meyer, M.D. Middleton (Madison), Wisconsin [log in to unmask] ******************************************************************************************