Insurance Co. VS Radiosurgery

[Sam]

For those whom have had Gammaknife/Cyberknife, What was the Insurance Co. reaction to your choice in treatment? I have Blue Cross Blue Shield, and I am a little worried that my Ins. Co. will cause a stink over my deciding to go with Gammaknife, being that it is the only option I have. I can not afford to fly to Los Angeles to House ear clinic for the surgical procedure. and there is a Gammaknife center about 200 miles from me. I was told by the doctor that the Gammaknife is FDA approved, and if the Ins. Co. decided to refuse to pay, I could have a hearing, and beat their decision based on the procedure being FDA approved. Has anyone run into this issue?
Thanks,
Sam

[krbonner]

Generally speaking, radiosurgery is an accepted protocol for treatment of ANs, so there "shouldn't" be a problem getting insurance to cover it.  It's not considered experimental treatment.  I also use BCBS (in MA), and have absolutely no trouble from them for anything (though I didn't have radiosurgery).  If it helps ease your mind, call BCBS and ask them about the policy, including what the procedure is to appeal decisions if needed.

Katie

[ppearl214]

Hi Sam and welcome.

Bruce and Katie *blows kiss to Katie* are most certainly right. Please let me see if I can also help clarify.

Both, GK and CK are FDA approved, thus, insurance companies do cover these treatment plans.  The key is... how much do they cover is all based on your individual insurance coverage.

I have BCBS of MA, had my CK at Beth Israel (an acute care facility).  Based on my plan, which is PPO, the entire process was covered 100% (for me) except for my dr office co-pays and Rx.  When you call BCBS, they will confirm that "stereotactic radio surgery" is covered (this applies to CK, GK, FSR, Proton) is covered, but it's trying to find out what your out of pocket is.

I know others here that had microsurgery with BCBS.  Some had co-pays of 80%-20% (one even had surgery at House Clinic and still had to pay quite a bit out of pocket).

Many insurance companies look to see if you are having your treatment in-state. Sometimes that is key, unless your treating dr will verify the medical necessity of the procedure to be done out of state.

Not sure if any of this helps, but I had no issues with BCBS and my treatment.

May it go easy for you as well.

Phyl

[Sam]

Thank you ALL. I plan to call BCBS tomorrow to explain what the doctor had proposed on my options, and call to let the doctor know what I have chosen to do. My doctor told me that he could perform the procedure within the next 1-2 weeks. Its time to GIT-R_DUN. and get on with my life.

Sam

[rntiggergirl]

Hi
I have worked for insurance companies for several years.  If you are concerned about them covering your procedure then have your physician send in medical information to your insurance carrier and request a "predermination" for your procedure.  You can call your customer service and ask them what you need to do to get a predetermination.  This is the safest way to do it then you will know if it will be covered before your surgery (most doctors offices do this for you automatically because they want to know if they are going to get paid) Also you can speak to the doctors office and ask them if they have had any problems getting reimbursed for the procedure by bcbs. 

Hope this helps. Good luck.

I have BCBS.  I had my surgery at House Ear Clinic/St Vincents Hospital. Both are in network for my PPO. I also live an hour from Los Angeles so I feel very blessed. 

Cheryl

[Sue]

I concur with everyone else.  In fact, I've heard that they prefer radiosurgery because it maybe cheaper for them because of less risk from complications.  If something untoward should happen after microsugery and your hosptital stay runs longer than anticipated due to problems then your bill will no doubt be much higher than the radiosurgery bill.  The bill that was presented to my insurance was $66,300 and change, by the way, so radiosurgery ain't cheap!!  Good luck with your treatment and recovery.

Sue in Vancouver, USA

[windinthesails]

Hi,
 Ã‚  I actually I had Gammaknife this past June and had Blue Cross in CA as my insurance company and had no problems with them paying. It was actually when I had the surgery before to partially remove the tumor that the company wouldnt pay all the bill, but no problems with the Gamma Knife. I know insurance companies can be a real pain sometimes so I hope this helps. Goodluck!
 Ã‚   Mary

[Sam]

Once again Thank you to all. I work with the public on a daily basis, and have to say if the rest of the world were like the people on this site, our world would be a Great place. It seems our society has become so insensitive, especially to people who have sickness.
I am glad I found this site!

Sam

[Sam]

I called BCBS and found out I am covered 100%.

[Nancy P]

Oh My!  I don't have the final word yet but it is sounding like my insurance, UNIFORM MEDICAL, is balking at paying for radiation treatment.  The RN reviewing my case seems to think that surgery is the treatment choice for acoustic neuromas.

Do any of you have Uniform Medical?  If so, have you had any problems with them approving radiation treatment?  In particular, I am wanting to have CK....soon, I  hope.

Nancy

[Obita]

Hi Nancy P:

Oh my gosh!!  Sounds like that RN is still back in the dark ages.

I hope your Radiaton Oncologist is good at writing letters.  If it is cost, as a comparision, my surgery and 3 days in the hospital was just over $65,000.00.  One day was ICU.  And the normal for a surgical patient stay is about 5 days.

I just had a wake up call here.  I assumed GK/CK etc...was the norm now for AN treatment.

Good luck and welcome to the forum.  Kathy

[Sue]

When I saw my GK bill I was flabbergasted.  They billed my insurance for over $66,000.00.  I, then assumed, that surgical patients could run into the hundreds of thousands of dollars. Guess we are about equal.  Insurance should pay for whatever approach doctors and patients agree on.  But then, what do I know?  Insurance seems to rule the world, or so they'd like to think. 

Sue in Vancouver

[Nancy P]

 Good news!  I just got word today that my insurance has approved the CK at Stanford.  I guess the 40+ plages of doctors summaries regarding radiation treatment did the trick.  I am glad to have that part behind me now.  Tonight I will schedule my air travel and get this on the books.  As strange as it is, I will be glad to get past the treatment part of this tumor.  It tends to wear on you after a while.

Nancy

[pearchica]

I have Blue Shield PPO- I have a high deductible- $4,000 per year, but cheap monthly rates. Stanford is a "contracted" provider with Blue Shield- critical terminology in insurance speak.  Once I fill the deductible, everything else is covered.  I asked the Stanford bookeeper to send me an estimate.  Haven't recieved it yet so will track it down with him post treatment.  I want to share the overall expense of this deal as I always am on the watch out for the "business motivation" behind medical procedures.

[pearchica]

OOOPS I hit post before I was finished. DUH- loopy girl signing off- Annie