Infusion treatments such as IVIG and Ketamine or Lidocaine (inpatient/outpatient) are not covered by insurance companies. They typically say that it is experimental or not FDA approved for the type of application that a doctor/patient wants to use for treatment of chronic pain conditions. For instance, "On the other hand, there is a lack of scientific evidence on the effectiveness of intrapleural analgesia for treatment of complex regional pain syndrome with chronic pain involving the thoracic dermatomes." is found in the Aetna Insurance information on RSD/CRPS treatments. In their Clinical Policy Bulletin: CRPS/RSD: Treatments, Number 0447-III, it is stated, “Aetna considers intravenous administration of Ketamine or Lidocaine (including "Ketamine coma") or midazolam experimental and investigational for the treatment of CRPS and other types of chronic pain because its effectiveness for these indications has not been established.” The last time they reviewed this policy was 2/12/2010. In that same policy statement under Background you will also find:
"In a case report, Shirani et al (2008) described the effect of Ketamine infusion in the treatment of severe refractory CRPS I. The patient was initially diagnosed with CRPS I in her right upper extremity. Over the next 6 years, CRPS was consecutively diagnosed in her thoracic region, left upper extremity, and both lower extremities. The severity of her pain, combined with the extensive areas afflicted by CRPS, caused traumatic emotional problems for this patient. Conventional treatments failed to provide long-term relief from pain. The patient was then given several infusions ofIV Ketamine. After the 3rd infusion, the edema, discoloration, and temperature of the affected areas normalized. The patient became completely pain-free. At 1-year follow-up, the patient reported that she has not experienced any pain since the last Ketamine infusion. The authors concluded thattreatment withIV Ketamine appeared to be effective in completely resolving intractable pain caused by severe refractory CRPS I. Moreover, they stated thatmore research on this treatment is needed to better define its effectiveness in CRPS."
In a pilot study, Kiefer and colleagues (2008) investigated the effectiveness of subanesthetic isomeric S(+)-Ketamine in refractory CRPS patients. Four refractory CRPS patients received continuous S(+)-Ketamine-infusions, gradually titrated (50 mg/day - 500 mg/day) over a 10-day period. Pain intensities (average, peak, and least pain) and side effects were rated on visual analog scales, during a 4-day baseline, over 10 treatment days, and 2 days following treatment. Quantitative sensory testing (QST: thermo-, mechanical detection, and pain thresholds) was analyzed at baseline and following treatment. Subanesthetic S(+)-Ketamine showed no reduction of pain and effected no change in thermo- and mechanical detection or pain thresholds. This procedure caused no relevant side effects. The lack of therapeutic response in the first 4 patients led to termination of this pilot study. The authors concluded that S(+)-Ketamine can be gradually titrated to large doses (500 mg/day) without clinically relevant side effects. There was no pain relief or change in QST measurements in this series of long-standing severe CRPS patients.
In an open label phase II study, Kiefer et al (2008) examined the effectiveness of Ketamine in anesthetic dosage in refractory CRPS patients who had failed available standard therapies. A total of 20 American Society of Anesthesiologists (ASA) I-III patients suffering from refractory CRPS received Ketamine in anesthetic dosage over 5 days. Outcome criteria were pain relief, effect on the movement disorder, quality of life, and ability to work at baseline and up to 6 months following treatment. Significant pain relief was observed at 1, 3, and 6 months following treatment (93.5 +/- 11.1 %, 89.4 +/- 17.0 %, 79.3 +/- 25.3 %; p < 0.001). Complete remission from CRPS was observed at 1 month in all patients, at 3 months in 17, and at 6 months in 16 patients. If relapse occurred, significant pain relief was still attained at 3 and 6 months (59.0 +/- 14.7 %, p < 0.004; 50.2 +/- 10.6 %, p < 0.002). Quality of life, the associated movement disorder, and the ability to work significantly improved in the majority of patients at 3 and 6 months. The authors concluded that these findings suggest benefit in pain reduction, associated CRPS symptoms, improved quality of life and ability to work following anesthetic Ketamine in previously refractory CRPS patients. However, they stated that a randomized controlled trial will be needed to prove its effectiveness.
There are many other reference made on this same section of why Aetna makes the choice not to cover Ketamine infusions at this time. They are not alone, many insurance companies are following similar guidelines. Medicare which typically denies many claims and treatments for RSD tends to cover Ketamine Infusions for most patients and the use of Ketamine in the treatment of RSD is FDA approved. Pain patients seeking IVIG infusions tend to hear the same excuses used as to why the insurance companies are not covering the treatment.
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If a modality is FDA approved it means your insurance cannot deny this treatment, but the FDA also gives a list of what conditions it is approved for. If you fall into a category such as peripheral neuropathy you don’t have such luck with IVIG therapy and will be in constant battle with your insurance company to get treatments of this type. IVIG approved for use by FDA for only the following 6 conditions; Primary immunodeficiencies, Immune-mediated thrombocytopenia, Kawasaki disease, Hematopoietic stem cell transplantation in patients older than 20 years (Gamimune-N only), Chronic B-cell lymphocytic leukemia and Pediatric HIV type 1 infection according to the FDA website.
First, this petition raises awareness of benefits the infusion therapies can bring to increasing the quality of life, health and physical abilities of chronic pain patients with Neuropathy conditions. If a patient and doctor are in agreement and studies show that there is a significant improvement in symptoms, insurance companies should be faster at approving these therapies for such Neuropathy conditions, especially when the modality is already approved for other conditions that are being covered by that insurance company. Secondly, we are also using this petition to raise awareness for patients that do not know that other options exist and if interested in infusion treatments they should speak with their healthcare providers about the risks and benefit of such therapy and if they would be a good candidate for the treatment.
Updates
July 15, 2017
Seeing this grow makes me feel less alone in the fight for my own treatment coverage. My body knows the reality of this pain despite what these outdated insurance policies claim. Thank you for validating the need for change.
Reached 100 supporters
July 15, 2017
74 Comments
Why would insurance companies deny relief from debilitating pain?
Insurance companies should not be allowed to deny effective treatment.
If insurance would cover this, I might be able to get rid of my pain once and for all. Even if it doesn't work for me, I know this treatment has given several people their lives back. It's a horrible disservice not to cover this procedure.
My 12 year old has had crps for a year would love to get this done for her
If something like this is cheaper than a lifetime on meds and ect therapy don't work. Why can't we do the right thing and help people pay for it? Sad!! I guess pharmaceutical companies will lose money. By no means is this a cure. But like they say no money in a cure! Very sad truth!
I suffer from SRDS and severe depression; I'm a student so I don't want to be on fentanyl and don't respond to any antidepressants. I've tried the ketamine and it helped with both but I cannot afford to pay for a full course of therapy. It would be nice if insurance would help- maybe then I could stop taking the 7 or 8 Meds I take btw the two.
dO YOUR JOB AS AN INSURANCE COMPANY AND PAY FOR TREATMENTS THAT HAVE BEEN PROVEN TO BRING SUBSTANTIAL RELEIF OF SYMPTOMS THAT YOU YOURSELF OBVIOUSLY DO NOT HAVE OR THIS PETITION WOULD NOT BE AN ISSUE.
I am writing on behalf of my wife Mary. Mary is diagnosed with depression but also suffers from CRPS from a fall which broke her wrist and damaged the brachial plexus under her left arm. She has been in constant, severe pain (level 8-10) since the accident in July 2011. She has always been one who doesn’t complain, but the pain is wearing her down. She was a patient of a local doctor here in VT. He administered one ketamine infusion before leaving the hospital to open his private practice, leaving her with no one to continue the treatments. The treatment transformed her from bed-ridden to GARDENING literally overnight. She is now taking ketamine troches, but they are much less effective than the infusions. Please provide coverage for this life-saving ketamine infusions. The pain is worsening her depression. Thank you.
Infusion Therapy for Ketamine has undergone several FDA Approved Studies and the progress has been amazing for the treatment of Depression. In fact it is now being used in hospitals everywhere to treat acute suicidal patients in Emergency Rooms. It has been shown to relieve the symptoms in a short period of time. It is in trials for Nasal Spray. Some insurance companies are paying for it because it is a far less expensive treatment than inpatient care or ECT, a very invasive procedure. My research shows that Regular Medicare will pay for it but it is yet to be approved by commercial policies since they have the loop hole of it being considered experimental. If you have a commercial policy such as United Health Care through AARP it is a wise choice to opt out of that plan and enroll in Regular Medicare. I have a family member who was pushed into ECT because it is more lucrative for the hospitals as well. Someone with a mental illness, I was told by the Hospital Administrator would have better Mental Health coverage under Regular Medicare than if they went with a Commercial policy and then added a drug plan and riders. The only way insurance will be forced to cover these costs is if people stop using them and they lose profits. It is the only language they understand. Remember, they are contracted with Medicare but they can deny services that are considered experimental or are NOT FDA approved for the specific use of the drug. Also is you are looking for the CPT code for this therapy it is 90865. Call you insurer and request they cover these procedures and lest save lives. If they do not, either find on that does or go with Regular Medicare. Also see www.webpsychiatry.com for more detailed information. You may also do a search for clinical trials in your area and sign up for a trial to see if it works for you.
After reading several reports, including those by the NIH, all saying the same thing: "Quality of life, the associated movement disorder, and the ability to work significantly improved in the majority of patients," it is absolutely astonishing to learn Ketamine treatments are STILL not FDA approved and therefore not covered by insurance. As a person with an extensive, albeit previous, background in healthcare, I find this appalling! Just to imagine the possibility that if these treatments where known and covered a long time ago, I might have been able to return to my career instead of languishing, worthlessly in Disability Land, this makes me angry and want to cry! I was a Physician Assistant working in the Deptartment of Anesthesia at a large university hospital. The FDA holds the POWER to allow me to go back to work, yet they will not act? WHY?????? It becomes abundantly clear that the FDA and insurance companies are not at all concerned with a person's Quality of Life. It makes much more sense to have us continue pursuing even more expensive, potentially riskier therapies, which ARE FDA approved and covered by [most] insurance. WHAT did I just write? NO! This makes NO sense whatsoever. The insurance companies obviously don't realize the potential savings here. And what is the FDA's excuse for all these years of dragging their feet when study after study has clearly proven the benefits of Ketamine, not only for chronic pain conditions, but equally effective for depressive disorders and ALL who suffer with daily pain ARE depressed! It makes more sense to keep us on narcotics and antidepressants?! CMS has already made it nearly impossible for responsible people who suffer from valid pain conditions to even obtain pain meds any longer, in addition to raising what we have to pay for these necessary "crutches" to survive to HALF! Yes, our government agencies are quick to act if and when they choose, by punishing the innocent because of those who abuse and
I am a crps/ adhesive spinal arachnoiditis sufferer. I would like to see ketamine approved by insurance companies especially in lieu of the cdc guidelines scaring the crap out of doctors who don't want to prescribe high enough meds to help the psin.
I get a kick out of it. Its always the people who need it the most who never are able to pay for the treatment.
I also want to petition for use of ketamine infusion for bipolar depression.to be covered by insurance.
My daughter has rsd and is desperate need of a ketamine treatment. She has been getting them for several years and they help her so much. Prior to a recent divorce they were covered by her husbands insurance and now she cannot find an insurance company in ga to cover it. We don't know what to do.
The people take care of the government, not the other way around. The mis appropriations, the salaries, the pensions, the best insurance offered, the engagements, sitting as board members on various companies, they have taken care of while in office, to keep the money rolling in. It's criminal, our government is criminal. That saying "a few bad apples can spoil the whole bag" is the opposite for our government, "all the bad apples in our government can't let the few good make a difference". Our everyday lives are just to be manipulated for their gain. I have no faith in our government, none whatsoever and that goes for every branch of the government. Corruption spreads. Big, Big change is needed. Not words out of the "elected" officials mouths.
It is time, past time for insurance/Medicare to pay for ketamine infusion therapies. It has been shown in hundreds of clinica l trials for CRPS, RSD, Chronic Pain and Treatment Resistant Depression. At a way less expensive pricetag, ketamine has shown great promise. For the diagnoses above, traditional treatments run 100s of thousandd of dollars over a lifetime. Of course, pharma is not pleased due to a glaring lack of profit. Please.
Need for chronic pain - maybe my only answer -
I need something for pain
Aetna please cover ketamine infusion for treatment resistant depression.
I need this treatment for nerve pain
I'm a 9 year probably going on 10 year early next year CRPS patient. I've been living with this disease since I was 30 years old, I'm now 39. I've been on pain medication for over 8 years but have since gotten off b/c of the ill side effects it was causing plus it was no longer working and hadn't been for almost a year before that. I'm a CRPS type 1 unfortunately, my diagnosis came after a year and a 1/2 if onset. I had also 2 more surgeries on that exact injury site as the doctor was not listening to my concerns before hand. That same doctor didn't recognize the CRPS when it was obvious about 4 weeks after initial surgery was done. Needless to say I've been in pain management for over 9 years now and have done all the nerve blocks, epidural shot, pain meds, neurontin, 6 years of physical therapy and I've had the SCS implanted 3 times with my last one implanted on March 31st 2016. I've had no luck with the SCS I've had implanted and calling that a done deal. With those SCS procedures it has left me numb in my right leg also with permanent spinal cord damage. This last implantation we think, not known yet but finding out soon, has also left me with more spinal cord damage which is affecting my muscles in the same numb leg. This surgery was done by a different doctor in another city about 239 miles away. My muscles have almost since quit functioning which occured about 6 weeks ago and have rapidly gotten worse. Though their other signs leading up to it that lead onset to be in early June but no one caught them nor did I. Basically, other than pain meds my CRPS has been running rampant in my lower half of my body for almost 10 years. I've got it in both legs and lower back have been told it'll eventually get it in my thoracic part of my back. The ketamine treatments I happen to stumble upon reading up on the newest information of CRPS compared to what was known 9 years. This is something I'm very interested in talking about further with the right doctor she would love
So many of us out here need to try ketamine asap. ALL other meds & treatments have failed so many including myselp. I need to be able to try ketamine thete is nothing left & my life is unbareable! 17 yrs & not going to keep counting!
This treatment is an essential tool for people suffering from chronic pain, and I see higher suicide rates in the future without more effective alternatives - that should be available to us!
I've had these treatments and they work. Insurance Companies and Medicare please pay for these treatments.
Now!
my husband has been disgnosed with crps and lives with excruciating burning pain in his legs, abdomen and back every moment of every day. I have literally watched as his joints swelled to the size of small balloons and turned bright red and then deflated almost as quickly while lying perfectly still in bed. these infusions offer hope, a brief respite fromt he constant pain and hopefully will lead to a cure but we need you to recognize their usefulness with this disease process. We've onlyu just begun to understand how the nervous system acts with this process and we need help until the medical community can identify the triggers and a cure. please.
Will sign get 6 a year in Canada as OHIP covers that much. Will be advocating for more. Use to be 12 a year but our health care cut it back to 6
My wife has rsd and need ketamine infusion therapy
If I get lumbar injections for my herniated disc the treatment cost 400$ each treatment plus the pain continues to remain I feel that with my condition would improve
The money saved over time with this treatment is tremendous. There is quite a successful track record for ketamine as a treatment for depression. It should be covered.
I strongly support the coverage of iv ketamine for depression because I know firsthand how well it works. It would save lives and cut costs dramatically.
I have fibromylgia since 2007 for the last 10 years my life has been falling apart. I don't have the money to pay for this out of pocket when I have BC/BS and Medicare. It hurts that so many want their lives back and no one wants to help us. Every year gets worse and worse because I'm not the only one suffering my family is and that hurts so much it brakes my heart. We ALL need our lives back.
I suffer from very severe pain head to toe. I have had 70 surgeries, every kind of pain treatment, physical therapy, etc. Nothing has helped. I was also disabled by a dr and have so much additional pain. I am only 48 and I want my life back. I need insurance to cover ketamine infusions. I make very little disability income.
I AM IN CHRONIC PAIN DUE TO MANY AUTO-IMMUNE DISEASES. I HAVE BEEN SICK SINCE 1991, AND HAD TO STOP WORKING AS AN RN IN APRIL OF 1992. I HAVE SYSTEMIC LUPUS, SYSTEMIC SARCOIDOSIS, RHEUMATOID ARTHRITIS, & MANY OTHER CONDITIONS. I ALSO SUFFERED A STROKE IN 1997, AND CANNOT HAVE A MORPHINE PUMP INSERTED INTO MY SPINAL CANAL DUE TO CHRONIC ANTI-COAGULATIONS NEEDS. I WAS TOLD THAT KETAMINE/LIDOCAINE INFUSIONS WOULD HELP ME, BUT AFTER SEEING A DOCTOR IN PHILADELPHIA, I WAS TOLD THE UPFRONT COSTS FOR THE TREATMENTS WOULD BE $40,000 EVERY 2 WEEKS!!! WHO CAN AFFORD THIS??? I WAS BROKEN HEARTED AS I WAITED 3 YEARS FOR THIS APPOINTMENT, THEN TOLD I WOULD HAVE TO PAY OVER FORTY THOUSAND DOLLARS EVERY 2 WEEKS?? I NEED HELP.....PLEASE, PLEASE LISTEN. THERE ARE SO MANY PEOPLE WHO COULD BENEFIT FROM KETAMINE/LIDOCAINE INFUSIONS AND INSURANCES MUST PAY FOR IT, INCLUDING MEDICARE...SINCE MOST PEOPLE WITH SEVERE PAINFUL CONDITIONS ARE ON MEDICARE DUE TO DISABILITY....I CONTACTED MY LOCAL SENATOR, ROBERT CASEY FROM PA. WITH NO HELP.....I AM BEGGING FOR YOUR HELP. THANK YOU FOR LISTENING....IF YOU WANT TO KNOW MORE...E-MAIL ME AT: [email protected]
PLEASE, PLEASE FOR THOSE OF US WHO HAVE CHRONIC PAIN AND ARE MAXED OUT ON PAIN MEDICATION FROM PAIN MANAGEMENT DOCTORS AT LEADING HOSPITALS IN PENNSYLVANIA.....I BEG YOU...I WAS TOLD KETAMINE/LIDOCAINE TREATMENTS WOULD BENEFIT ME, BUT THE COST WAS $40,000 EVERY 2 WEEKS!!! HOW CAN ANYONE AFFORD THIS?? PLEASE HELP ME & SO MANY OTHERS...INSURANCE HAS GO TO PAY FOR THIS MUCH NEEDED TREATMENT FOR CHRONIC PAIN SUFFERERS DUE TO AUTO-IMMUNE DISEASES. I'M GOING TO DIE....I'M ONLY 53...BEEN SICK SINCE I'VE BEEN 27 YEARS OLD.
Ketamine has been proven to be safe from decades of use in anesthesia- even with children. If this medicine helps 1/10 of the people who are suffering, then it is worth it. I do not have chronic pain but I have treatment resistant depression and there is absolutely nothing that ketamine treatments could do to do me that would be worse than what mental illness already has. People are suffering; they want to die. Give us some hope and fast track this times 10. Hurry up. People's lives are depending on this.
Many patients will benefit from ketamine infusion therapy. Any help would be greatly appreciated.
I've tried every pain med nothing works in the long time. We need another option
I am one who will push for insurance to cover the cost. Most of us who live with this severe pain 24/7 are unable to pay for the treatment on our own due to extreme expense. I truly hope insurance will soon change their mind and cover this last beacon of hope.
If you take away my pain medications then you should cover the only other treatment for pain relief with my pain condition
I think that if this is a good medicine to help people like me who suffer with severe PTSD and serious pain in the cervical, thoracic, and lumbar spine it's worth the FDA doing what it takes to test it properly and then insurance would cover it...
I have a rare autoimmune neuropathy that is painful and standard medications are not working for the pain. I don't know how much longer I can work. I think the insurance should at least let me try the infusions to see if it will help
I am in constant in extreme pain from my fiber mount Jack and my neuropathy in my feet in length I really won't help I also have other body pains but I would love for someone to step up and let us have this treatment for neuropathy please please is so badd and there's nothing else they can do I have had nerve blocks and it does not help please I'm signing this petition in hill said it would also help others besides myself....
I used Ketamine infusions for RSD It also helped with my depression !! After over 4 yrs. my insurance company decided not to cover Ketamine infusions!! I was left with severe ,intense pain And major depression again !! It’s so sad to measure my best times with using Ketamine infusions and have iit abruptly taken away left with no help at all!
It is a huge concern that the insurance industry supports the continued use of opioides for the treatment of pain associated with CRPS/RSD but does not support the hope for remission of the disorder.
Since this is a good alternative to opioid use for pain, it should be covered by Medicare and insurance. It only makes sense.
This needs to be covered both for the mitigation of chronic depression, bipolar depression, chronic pain syndromes like CPRS, and all other depression or pain causing illnesses of high enough severity to interfere with ones ability to function normally. It's not fair that only the rich can afford to restore themselves.
Doctors won’t provide pain medications. Nothing else works. Ketamine has been shown to be effective in chronic pain but is unaffordable. Insurance needs to cover it. People with chronic pain deserve treatment that works.
Im a CRPS Patient
I have had depression, PTSD and chronic pain for years. I am on disability and can't afford ketamine treatments. I find it ridiculous they will pay for rehab for people who become alcoholics and drug addicts by their bad choices but no help for people who by no choice of their own are left to suffer because Medicare refuses to help them. Any ideas on help? Thank you.
Ketamine for Depression use
FDA APPROVES DRUGS FOR CRPS IN OTHER COUNTRIES ?WHAT IS GOING ON?
On Medicaid for PTSD, anxiety,depression.
I hope and pray that none of the people responsible for deciding what’s covered regarding the treatment of chronic pain never have to experience the feeling of having no relief in sight for their lives which can’t really be defined as living!!!!
Please cover Ketermine it is important to the mind body and overal mental health condition! That says it all and it should be covered, the savings in the long run would save the insurance companies a boat load of money!!
My daughter has had severe pain for 18 years. It took 10 years to get a diagnosis. in 2011 she had her first Ketamine treatment . It gave her at least a 80 % relief from the daily pains. She suffers from very serve shocking pains due to the condition. She has never been able to hold a job due to the constant pains. I her mother and caregiver had to retire early when her Pains started. I am unable to hold a job. We cannot afford to get her the Ketamine treatments and Treating chronic pain seems to be a " bad" thing by ER's etc. Please add Ketamine treatments for chronic pain as CRPS, to the "covered" under Medicare. This is a terrible condition and affects whole families and the majority can not afford the Ketamine treatments that can help so many people. The numbers are staggering This condition has been considered the subside condition as so many , even Veterans can not get this treatment. Thank You '
I have had CRPS for the past 18 yrs due to a doctors mistake and I’m trying to get my insurance to pay for these ridiculous frees for the infusion therapy. I’m in Louisiana and the cost is $400 per infusion and they want to do 6 to start with a booster every 4-8 week..
Low dose ketamine infusion has helped me with my treatment resistant depression.
I am on acchs Arizona. I have suffered 18 years and am treatment resistant. Depression affects everyone regardless of income. Please help us.
This is essential treatment for a disease (treatment-resistent depression) where we have essentially no other effective methods.
My psych doctor recommended me to try Ketamine infusions for depression multi symptoms. However the cost is around 1000.00$ per session which I cannot afford being on SSDI.
It doesn't make sense NOT to pay for this lifesaving treatment. A ketamine infusion costs much less than Esketamine but insurance companies will pay for that? Does anyone care about mental health?
I will eventually die from my treatment resistant depression and PTSD. I have tried every med,TMS, ECT which I believe has left permanent brain damage. I have nothing left to try. I am on SSDI, because I am an RN and unable to perform my job due to severe depression. It has taken 99% of my life away. To know that there is a possible effective treatment right down the street, but it is cost prohibitive because insurance companies won't pay for it. I was inpatient hospitalized from November 2020-March 2021. How much do you suppose that cost?
Is RSDSA working with this group? RSDS.org
No getting ketamine for my full body crps is making my body deterate. I can’t heal from surgery that’s causing more surgery. I’m in constant burning pain. This is a cancer that requires treatment I only respond to ketamine. I’m opioid resistant
I suffered a work accident. I tore my rotator cuff,which lead to scapula winging, brachial plexus injury tos syndrome and now rsd.
I FEEL IF THERE IS SOMETHING AVAILABLE AND FDA APPROVE INSURANCE SHOULD NOT OR EVEN HAVE THE RIGHT TO PREVENT COVERAGE.
Diagnosed with Dercums type 1 & 3, Ehlers-Danlos, Angiolipomatosis, Peripheral neuropathy, MCAS, & Intractable Pain Syndrome
Lidocaine infusions are essential in the management of my pain.
Lidocaine infusions are essential in the management of my pain.
I have Aetna and they are denying coverage for a 5 day inpatient ketamine infusion (will need to travel out of state). However, they HAVE been paying for my outpatient infusions (done locally) and my oral ketamine. I have been through 2 appeals, which were denied based on ketamine being experimental (even though I have PROOF they have paid for my outpatient infusions locally and my oral medication). Now I am at the 3rd level of appeal, which will go to the State, who will then assign a third "neutral" party to evaluate the case and make a determination. Please pray for me!
Yes - This should absolutely be an option!
It should be an option
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Infusion treatments such as IVIG and Ketamine or Lidocaine (inpatient/outpatient) are not covered by insurance companies. They typically say that it is experimental or not FDA approved for the type of application that a doctor/patient wants to use for treatment of chronic pain conditions. For instance, "On the other hand, there is a lack of scientific evidence on the effectiveness of intrapleural analgesia for treatment of complex regional pain syndrome with chronic pain involving the thoracic dermatomes." is found in the Aetna Insurance information on RSD/CRPS treatments. In their Clinical Policy Bulletin: CRPS/RSD: Treatments, Number 0447-III, it is stated, “Aetna considers intravenous administration of Ketamine or Lidocaine (including "Ketamine coma") or midazolam experimental and investigational for the treatment of CRPS and other types of chronic pain because its effectiveness for these indications has not been established.” The last time they reviewed this policy was 2/12/2010. In that same policy statement under Background you will also find:
"In a case report, Shirani et al (2008) described the effect of Ketamine infusion in the treatment of severe refractory CRPS I. The patient was initially diagnosed with CRPS I in her right upper extremity. Over the next 6 years, CRPS was consecutively diagnosed in her thoracic region, left upper extremity, and both lower extremities. The severity of her pain, combined with the extensive areas afflicted by CRPS, caused traumatic emotional problems for this patient. Conventional treatments failed to provide long-term relief from pain. The patient was then given several infusions ofIV Ketamine. After the 3rd infusion, the edema, discoloration, and temperature of the affected areas normalized. The patient became completely pain-free. At 1-year follow-up, the patient reported that she has not experienced any pain since the last Ketamine infusion. The authors concluded thattreatment withIV Ketamine appeared to be effective in completely resolving intractable pain caused by severe refractory CRPS I. Moreover, they stated thatmore research on this treatment is needed to better define its effectiveness in CRPS."
In a pilot study, Kiefer and colleagues (2008) investigated the effectiveness of subanesthetic isomeric S(+)-Ketamine in refractory CRPS patients. Four refractory CRPS patients received continuous S(+)-Ketamine-infusions, gradually titrated (50 mg/day - 500 mg/day) over a 10-day period. Pain intensities (average, peak, and least pain) and side effects were rated on visual analog scales, during a 4-day baseline, over 10 treatment days, and 2 days following treatment. Quantitative sensory testing (QST: thermo-, mechanical detection, and pain thresholds) was analyzed at baseline and following treatment. Subanesthetic S(+)-Ketamine showed no reduction of pain and effected no change in thermo- and mechanical detection or pain thresholds. This procedure caused no relevant side effects. The lack of therapeutic response in the first 4 patients led to termination of this pilot study. The authors concluded that S(+)-Ketamine can be gradually titrated to large doses (500 mg/day) without clinically relevant side effects. There was no pain relief or change in QST measurements in this series of long-standing severe CRPS patients.
In an open label phase II study, Kiefer et al (2008) examined the effectiveness of Ketamine in anesthetic dosage in refractory CRPS patients who had failed available standard therapies. A total of 20 American Society of Anesthesiologists (ASA) I-III patients suffering from refractory CRPS received Ketamine in anesthetic dosage over 5 days. Outcome criteria were pain relief, effect on the movement disorder, quality of life, and ability to work at baseline and up to 6 months following treatment. Significant pain relief was observed at 1, 3, and 6 months following treatment (93.5 +/- 11.1 %, 89.4 +/- 17.0 %, 79.3 +/- 25.3 %; p < 0.001). Complete remission from CRPS was observed at 1 month in all patients, at 3 months in 17, and at 6 months in 16 patients. If relapse occurred, significant pain relief was still attained at 3 and 6 months (59.0 +/- 14.7 %, p < 0.004; 50.2 +/- 10.6 %, p < 0.002). Quality of life, the associated movement disorder, and the ability to work significantly improved in the majority of patients at 3 and 6 months. The authors concluded that these findings suggest benefit in pain reduction, associated CRPS symptoms, improved quality of life and ability to work following anesthetic Ketamine in previously refractory CRPS patients. However, they stated that a randomized controlled trial will be needed to prove its effectiveness.
There are many other reference made on this same section of why Aetna makes the choice not to cover Ketamine infusions at this time. They are not alone, many insurance companies are following similar guidelines. Medicare which typically denies many claims and treatments for RSD tends to cover Ketamine Infusions for most patients and the use of Ketamine in the treatment of RSD is FDA approved. Pain patients seeking IVIG infusions tend to hear the same excuses used as to why the insurance companies are not covering the treatment.
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If a modality is FDA approved it means your insurance cannot deny this treatment, but the FDA also gives a list of what conditions it is approved for. If you fall into a category such as peripheral neuropathy you don’t have such luck with IVIG therapy and will be in constant battle with your insurance company to get treatments of this type. IVIG approved for use by FDA for only the following 6 conditions; Primary immunodeficiencies, Immune-mediated thrombocytopenia, Kawasaki disease, Hematopoietic stem cell transplantation in patients older than 20 years (Gamimune-N only), Chronic B-cell lymphocytic leukemia and Pediatric HIV type 1 infection according to the FDA website.
First, this petition raises awareness of benefits the infusion therapies can bring to increasing the quality of life, health and physical abilities of chronic pain patients with Neuropathy conditions. If a patient and doctor are in agreement and studies show that there is a significant improvement in symptoms, insurance companies should be faster at approving these therapies for such Neuropathy conditions, especially when the modality is already approved for other conditions that are being covered by that insurance company. Secondly, we are also using this petition to raise awareness for patients that do not know that other options exist and if interested in infusion treatments they should speak with their healthcare providers about the risks and benefit of such therapy and if they would be a good candidate for the treatment.
Updates
July 15, 2017
Seeing this grow makes me feel less alone in the fight for my own treatment coverage. My body knows the reality of this pain despite what these outdated insurance policies claim. Thank you for validating the need for change.
Reached 100 supporters
July 15, 2017
74 Comments
Why would insurance companies deny relief from debilitating pain?
Why would insurance companies deny relief from debilitating pain?
Insurance companies should not be allowed to deny effective treatment.
If insurance would cover this, I might be able to get rid of my pain once and for all. Even if it doesn't work for me, I know this treatment has given several people their lives back. It's a horrible disservice not to cover this procedure.
My 12 year old has had crps for a year would love to get this done for her
If something like this is cheaper than a lifetime on meds and ect therapy don't work. Why can't we do the right thing and help people pay for it? Sad!! I guess pharmaceutical companies will lose money. By no means is this a cure. But like they say no money in a cure! Very sad truth!
I suffer from SRDS and severe depression; I'm a student so I don't want to be on fentanyl and don't respond to any antidepressants. I've tried the ketamine and it helped with both but I cannot afford to pay for a full course of therapy. It would be nice if insurance would help- maybe then I could stop taking the 7 or 8 Meds I take btw the two.
dO YOUR JOB AS AN INSURANCE COMPANY AND PAY FOR TREATMENTS THAT HAVE BEEN PROVEN TO BRING SUBSTANTIAL RELEIF OF SYMPTOMS THAT YOU YOURSELF OBVIOUSLY DO NOT HAVE OR THIS PETITION WOULD NOT BE AN ISSUE.
I am writing on behalf of my wife Mary. Mary is diagnosed with depression but also suffers from CRPS from a fall which broke her wrist and damaged the brachial plexus under her left arm. She has been in constant, severe pain (level 8-10) since the accident in July 2011. She has always been one who doesn’t complain, but the pain is wearing her down. She was a patient of a local doctor here in VT. He administered one ketamine infusion before leaving the hospital to open his private practice, leaving her with no one to continue the treatments. The treatment transformed her from bed-ridden to GARDENING literally overnight. She is now taking ketamine troches, but they are much less effective than the infusions. Please provide coverage for this life-saving ketamine infusions. The pain is worsening her depression. Thank you.
Infusion Therapy for Ketamine has undergone several FDA Approved Studies and the progress has been amazing for the treatment of Depression. In fact it is now being used in hospitals everywhere to treat acute suicidal patients in Emergency Rooms. It has been shown to relieve the symptoms in a short period of time. It is in trials for Nasal Spray. Some insurance companies are paying for it because it is a far less expensive treatment than inpatient care or ECT, a very invasive procedure. My research shows that Regular Medicare will pay for it but it is yet to be approved by commercial policies since they have the loop hole of it being considered experimental. If you have a commercial policy such as United Health Care through AARP it is a wise choice to opt out of that plan and enroll in Regular Medicare. I have a family member who was pushed into ECT because it is more lucrative for the hospitals as well. Someone with a mental illness, I was told by the Hospital Administrator would have better Mental Health coverage under Regular Medicare than if they went with a Commercial policy and then added a drug plan and riders. The only way insurance will be forced to cover these costs is if people stop using them and they lose profits. It is the only language they understand. Remember, they are contracted with Medicare but they can deny services that are considered experimental or are NOT FDA approved for the specific use of the drug. Also is you are looking for the CPT code for this therapy it is 90865. Call you insurer and request they cover these procedures and lest save lives. If they do not, either find on that does or go with Regular Medicare. Also see www.webpsychiatry.com for more detailed information. You may also do a search for clinical trials in your area and sign up for a trial to see if it works for you.
After reading several reports, including those by the NIH, all saying the same thing: "Quality of life, the associated movement disorder, and the ability to work significantly improved in the majority of patients," it is absolutely astonishing to learn Ketamine treatments are STILL not FDA approved and therefore not covered by insurance. As a person with an extensive, albeit previous, background in healthcare, I find this appalling! Just to imagine the possibility that if these treatments where known and covered a long time ago, I might have been able to return to my career instead of languishing, worthlessly in Disability Land, this makes me angry and want to cry! I was a Physician Assistant working in the Deptartment of Anesthesia at a large university hospital. The FDA holds the POWER to allow me to go back to work, yet they will not act? WHY?????? It becomes abundantly clear that the FDA and insurance companies are not at all concerned with a person's Quality of Life. It makes much more sense to have us continue pursuing even more expensive, potentially riskier therapies, which ARE FDA approved and covered by [most] insurance. WHAT did I just write? NO! This makes NO sense whatsoever. The insurance companies obviously don't realize the potential savings here. And what is the FDA's excuse for all these years of dragging their feet when study after study has clearly proven the benefits of Ketamine, not only for chronic pain conditions, but equally effective for depressive disorders and ALL who suffer with daily pain ARE depressed! It makes more sense to keep us on narcotics and antidepressants?! CMS has already made it nearly impossible for responsible people who suffer from valid pain conditions to even obtain pain meds any longer, in addition to raising what we have to pay for these necessary "crutches" to survive to HALF! Yes, our government agencies are quick to act if and when they choose, by punishing the innocent because of those who abuse and
I am a crps/ adhesive spinal arachnoiditis sufferer. I would like to see ketamine approved by insurance companies especially in lieu of the cdc guidelines scaring the crap out of doctors who don't want to prescribe high enough meds to help the psin.
I get a kick out of it. Its always the people who need it the most who never are able to pay for the treatment.
I also want to petition for use of ketamine infusion for bipolar depression.to be covered by insurance.
My daughter has rsd and is desperate need of a ketamine treatment. She has been getting them for several years and they help her so much. Prior to a recent divorce they were covered by her husbands insurance and now she cannot find an insurance company in ga to cover it. We don't know what to do.
The people take care of the government, not the other way around. The mis appropriations, the salaries, the pensions, the best insurance offered, the engagements, sitting as board members on various companies, they have taken care of while in office, to keep the money rolling in. It's criminal, our government is criminal. That saying "a few bad apples can spoil the whole bag" is the opposite for our government, "all the bad apples in our government can't let the few good make a difference". Our everyday lives are just to be manipulated for their gain. I have no faith in our government, none whatsoever and that goes for every branch of the government. Corruption spreads. Big, Big change is needed. Not words out of the "elected" officials mouths.
It is time, past time for insurance/Medicare to pay for ketamine infusion therapies. It has been shown in hundreds of clinica l trials for CRPS, RSD, Chronic Pain and Treatment Resistant Depression. At a way less expensive pricetag, ketamine has shown great promise. For the diagnoses above, traditional treatments run 100s of thousandd of dollars over a lifetime. Of course, pharma is not pleased due to a glaring lack of profit. Please.
Need for chronic pain - maybe my only answer -
I need something for pain
Aetna please cover ketamine infusion for treatment resistant depression.
I need this treatment for nerve pain
I'm a 9 year probably going on 10 year early next year CRPS patient. I've been living with this disease since I was 30 years old, I'm now 39. I've been on pain medication for over 8 years but have since gotten off b/c of the ill side effects it was causing plus it was no longer working and hadn't been for almost a year before that. I'm a CRPS type 1 unfortunately, my diagnosis came after a year and a 1/2 if onset. I had also 2 more surgeries on that exact injury site as the doctor was not listening to my concerns before hand. That same doctor didn't recognize the CRPS when it was obvious about 4 weeks after initial surgery was done. Needless to say I've been in pain management for over 9 years now and have done all the nerve blocks, epidural shot, pain meds, neurontin, 6 years of physical therapy and I've had the SCS implanted 3 times with my last one implanted on March 31st 2016. I've had no luck with the SCS I've had implanted and calling that a done deal. With those SCS procedures it has left me numb in my right leg also with permanent spinal cord damage. This last implantation we think, not known yet but finding out soon, has also left me with more spinal cord damage which is affecting my muscles in the same numb leg. This surgery was done by a different doctor in another city about 239 miles away. My muscles have almost since quit functioning which occured about 6 weeks ago and have rapidly gotten worse. Though their other signs leading up to it that lead onset to be in early June but no one caught them nor did I. Basically, other than pain meds my CRPS has been running rampant in my lower half of my body for almost 10 years. I've got it in both legs and lower back have been told it'll eventually get it in my thoracic part of my back. The ketamine treatments I happen to stumble upon reading up on the newest information of CRPS compared to what was known 9 years. This is something I'm very interested in talking about further with the right doctor she would love
So many of us out here need to try ketamine asap. ALL other meds & treatments have failed so many including myselp. I need to be able to try ketamine thete is nothing left & my life is unbareable! 17 yrs & not going to keep counting!
This treatment is an essential tool for people suffering from chronic pain, and I see higher suicide rates in the future without more effective alternatives - that should be available to us!
I've had these treatments and they work. Insurance Companies and Medicare please pay for these treatments.
Now!
my husband has been disgnosed with crps and lives with excruciating burning pain in his legs, abdomen and back every moment of every day. I have literally watched as his joints swelled to the size of small balloons and turned bright red and then deflated almost as quickly while lying perfectly still in bed. these infusions offer hope, a brief respite fromt he constant pain and hopefully will lead to a cure but we need you to recognize their usefulness with this disease process. We've onlyu just begun to understand how the nervous system acts with this process and we need help until the medical community can identify the triggers and a cure. please.
Will sign get 6 a year in Canada as OHIP covers that much. Will be advocating for more. Use to be 12 a year but our health care cut it back to 6
My wife has rsd and need ketamine infusion therapy
If I get lumbar injections for my herniated disc the treatment cost 400$ each treatment plus the pain continues to remain I feel that with my condition would improve
The money saved over time with this treatment is tremendous. There is quite a successful track record for ketamine as a treatment for depression. It should be covered.
I strongly support the coverage of iv ketamine for depression because I know firsthand how well it works. It would save lives and cut costs dramatically.
I have fibromylgia since 2007 for the last 10 years my life has been falling apart. I don't have the money to pay for this out of pocket when I have BC/BS and Medicare. It hurts that so many want their lives back and no one wants to help us. Every year gets worse and worse because I'm not the only one suffering my family is and that hurts so much it brakes my heart. We ALL need our lives back.
I suffer from very severe pain head to toe. I have had 70 surgeries, every kind of pain treatment, physical therapy, etc. Nothing has helped. I was also disabled by a dr and have so much additional pain. I am only 48 and I want my life back. I need insurance to cover ketamine infusions. I make very little disability income.
I AM IN CHRONIC PAIN DUE TO MANY AUTO-IMMUNE DISEASES. I HAVE BEEN SICK SINCE 1991, AND HAD TO STOP WORKING AS AN RN IN APRIL OF 1992. I HAVE SYSTEMIC LUPUS, SYSTEMIC SARCOIDOSIS, RHEUMATOID ARTHRITIS, & MANY OTHER CONDITIONS. I ALSO SUFFERED A STROKE IN 1997, AND CANNOT HAVE A MORPHINE PUMP INSERTED INTO MY SPINAL CANAL DUE TO CHRONIC ANTI-COAGULATIONS NEEDS. I WAS TOLD THAT KETAMINE/LIDOCAINE INFUSIONS WOULD HELP ME, BUT AFTER SEEING A DOCTOR IN PHILADELPHIA, I WAS TOLD THE UPFRONT COSTS FOR THE TREATMENTS WOULD BE $40,000 EVERY 2 WEEKS!!! WHO CAN AFFORD THIS??? I WAS BROKEN HEARTED AS I WAITED 3 YEARS FOR THIS APPOINTMENT, THEN TOLD I WOULD HAVE TO PAY OVER FORTY THOUSAND DOLLARS EVERY 2 WEEKS?? I NEED HELP.....PLEASE, PLEASE LISTEN. THERE ARE SO MANY PEOPLE WHO COULD BENEFIT FROM KETAMINE/LIDOCAINE INFUSIONS AND INSURANCES MUST PAY FOR IT, INCLUDING MEDICARE...SINCE MOST PEOPLE WITH SEVERE PAINFUL CONDITIONS ARE ON MEDICARE DUE TO DISABILITY....I CONTACTED MY LOCAL SENATOR, ROBERT CASEY FROM PA. WITH NO HELP.....I AM BEGGING FOR YOUR HELP. THANK YOU FOR LISTENING....IF YOU WANT TO KNOW MORE...E-MAIL ME AT: [email protected]
PLEASE, PLEASE FOR THOSE OF US WHO HAVE CHRONIC PAIN AND ARE MAXED OUT ON PAIN MEDICATION FROM PAIN MANAGEMENT DOCTORS AT LEADING HOSPITALS IN PENNSYLVANIA.....I BEG YOU...I WAS TOLD KETAMINE/LIDOCAINE TREATMENTS WOULD BENEFIT ME, BUT THE COST WAS $40,000 EVERY 2 WEEKS!!! HOW CAN ANYONE AFFORD THIS?? PLEASE HELP ME & SO MANY OTHERS...INSURANCE HAS GO TO PAY FOR THIS MUCH NEEDED TREATMENT FOR CHRONIC PAIN SUFFERERS DUE TO AUTO-IMMUNE DISEASES. I'M GOING TO DIE....I'M ONLY 53...BEEN SICK SINCE I'VE BEEN 27 YEARS OLD.
Ketamine has been proven to be safe from decades of use in anesthesia- even with children. If this medicine helps 1/10 of the people who are suffering, then it is worth it. I do not have chronic pain but I have treatment resistant depression and there is absolutely nothing that ketamine treatments could do to do me that would be worse than what mental illness already has. People are suffering; they want to die. Give us some hope and fast track this times 10. Hurry up. People's lives are depending on this.
Many patients will benefit from ketamine infusion therapy. Any help would be greatly appreciated.
I've tried every pain med nothing works in the long time. We need another option
I am one who will push for insurance to cover the cost. Most of us who live with this severe pain 24/7 are unable to pay for the treatment on our own due to extreme expense. I truly hope insurance will soon change their mind and cover this last beacon of hope.
If you take away my pain medications then you should cover the only other treatment for pain relief with my pain condition
I think that if this is a good medicine to help people like me who suffer with severe PTSD and serious pain in the cervical, thoracic, and lumbar spine it's worth the FDA doing what it takes to test it properly and then insurance would cover it...
I have a rare autoimmune neuropathy that is painful and standard medications are not working for the pain. I don't know how much longer I can work. I think the insurance should at least let me try the infusions to see if it will help
I am in constant in extreme pain from my fiber mount Jack and my neuropathy in my feet in length I really won't help I also have other body pains but I would love for someone to step up and let us have this treatment for neuropathy please please is so badd and there's nothing else they can do I have had nerve blocks and it does not help please I'm signing this petition in hill said it would also help others besides myself....
I used Ketamine infusions for RSD It also helped with my depression !! After over 4 yrs. my insurance company decided not to cover Ketamine infusions!! I was left with severe ,intense pain And major depression again !! It’s so sad to measure my best times with using Ketamine infusions and have iit abruptly taken away left with no help at all!
It is a huge concern that the insurance industry supports the continued use of opioides for the treatment of pain associated with CRPS/RSD but does not support the hope for remission of the disorder.
Since this is a good alternative to opioid use for pain, it should be covered by Medicare and insurance. It only makes sense.
This needs to be covered both for the mitigation of chronic depression, bipolar depression, chronic pain syndromes like CPRS, and all other depression or pain causing illnesses of high enough severity to interfere with ones ability to function normally. It's not fair that only the rich can afford to restore themselves.
Doctors won’t provide pain medications. Nothing else works. Ketamine has been shown to be effective in chronic pain but is unaffordable. Insurance needs to cover it. People with chronic pain deserve treatment that works.
Im a CRPS Patient
I have had depression, PTSD and chronic pain for years. I am on disability and can't afford ketamine treatments. I find it ridiculous they will pay for rehab for people who become alcoholics and drug addicts by their bad choices but no help for people who by no choice of their own are left to suffer because Medicare refuses to help them. Any ideas on help? Thank you.
Ketamine for Depression use
FDA APPROVES DRUGS FOR CRPS IN OTHER COUNTRIES ?WHAT IS GOING ON?
On Medicaid for PTSD, anxiety,depression.
I hope and pray that none of the people responsible for deciding what’s covered regarding the treatment of chronic pain never have to experience the feeling of having no relief in sight for their lives which can’t really be defined as living!!!!
Please cover Ketermine it is important to the mind body and overal mental health condition! That says it all and it should be covered, the savings in the long run would save the insurance companies a boat load of money!!
My daughter has had severe pain for 18 years. It took 10 years to get a diagnosis. in 2011 she had her first Ketamine treatment . It gave her at least a 80 % relief from the daily pains. She suffers from very serve shocking pains due to the condition. She has never been able to hold a job due to the constant pains. I her mother and caregiver had to retire early when her Pains started. I am unable to hold a job. We cannot afford to get her the Ketamine treatments and Treating chronic pain seems to be a " bad" thing by ER's etc. Please add Ketamine treatments for chronic pain as CRPS, to the "covered" under Medicare. This is a terrible condition and affects whole families and the majority can not afford the Ketamine treatments that can help so many people. The numbers are staggering This condition has been considered the subside condition as so many , even Veterans can not get this treatment. Thank You '
I have had CRPS for the past 18 yrs due to a doctors mistake and I’m trying to get my insurance to pay for these ridiculous frees for the infusion therapy. I’m in Louisiana and the cost is $400 per infusion and they want to do 6 to start with a booster every 4-8 week..
Low dose ketamine infusion has helped me with my treatment resistant depression.
I am on acchs Arizona. I have suffered 18 years and am treatment resistant. Depression affects everyone regardless of income. Please help us.
This is essential treatment for a disease (treatment-resistent depression) where we have essentially no other effective methods.
My psych doctor recommended me to try Ketamine infusions for depression multi symptoms. However the cost is around 1000.00$ per session which I cannot afford being on SSDI.
It doesn't make sense NOT to pay for this lifesaving treatment. A ketamine infusion costs much less than Esketamine but insurance companies will pay for that? Does anyone care about mental health?
I will eventually die from my treatment resistant depression and PTSD. I have tried every med,TMS, ECT which I believe has left permanent brain damage. I have nothing left to try. I am on SSDI, because I am an RN and unable to perform my job due to severe depression. It has taken 99% of my life away. To know that there is a possible effective treatment right down the street, but it is cost prohibitive because insurance companies won't pay for it. I was inpatient hospitalized from November 2020-March 2021. How much do you suppose that cost?
Is RSDSA working with this group? RSDS.org
No getting ketamine for my full body crps is making my body deterate. I can’t heal from surgery that’s causing more surgery. I’m in constant burning pain. This is a cancer that requires treatment I only respond to ketamine. I’m opioid resistant
I suffered a work accident. I tore my rotator cuff,which lead to scapula winging, brachial plexus injury tos syndrome and now rsd.
I FEEL IF THERE IS SOMETHING AVAILABLE AND FDA APPROVE INSURANCE SHOULD NOT OR EVEN HAVE THE RIGHT TO PREVENT COVERAGE.
Diagnosed with Dercums type 1 & 3, Ehlers-Danlos, Angiolipomatosis, Peripheral neuropathy, MCAS, & Intractable Pain Syndrome
Lidocaine infusions are essential in the management of my pain.
Lidocaine infusions are essential in the management of my pain.
I have Aetna and they are denying coverage for a 5 day inpatient ketamine infusion (will need to travel out of state). However, they HAVE been paying for my outpatient infusions (done locally) and my oral ketamine. I have been through 2 appeals, which were denied based on ketamine being experimental (even though I have PROOF they have paid for my outpatient infusions locally and my oral medication). Now I am at the 3rd level of appeal, which will go to the State, who will then assign a third "neutral" party to evaluate the case and make a determination. Please pray for me!
Yes - This should absolutely be an option!
It should be an option
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Why would insurance companies deny relief from debilitating pain?