Insurance reimbursement for Infusions

Today CIGNA on a two hour phone call agreed to cover 80 percent of all of my infusions after the deductible of course. If my doctor was in network they would have paid 100 percent no deductible.
They use codes to determine eligibility so it will depend on what code your MD bills you on.
For NYKetamine patients this is good news if you have a plan that allows out of network visits.
They will not pay for any Ketamine troches because it’s on their list of experimental medicine.
Hope this helps.
M

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Hi there, that’s great to hear. For what indication if you don’t mind me asking? I think they’ve been more willing to cover it for CRPS than other conditions. Ty.

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Great news!

Hey thanks for posting. Did you have a pre infusion diagnosis for ptsd, anxiety, depression etc? Im wondering if that is a requirement for insurance to cover it

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Chronic PTSD

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PTSD Gunshot victim.

Also Anxiety and depression. It helps for all three. I just had my infusion. I hope that when we die a world like that exists. It is so comforting to watch The Universe move when on on ketamine. (In your imagination) I just finished my infusion; it was amazing!

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Do you all find it hard to describe the ketamine experience in words? My imagination is amazing! I wish I could share what I see and feel. Do any of the rest of you feel this way?

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That’s what my chart said from NY Ketamine. I have been diagnosed with many other conditions. Bad mommy and daddy. If they got the help they needed I may not be here getting mine. My son is doing a whole lot better than I was at his age and giving up my alcoholism when he was 7 helped a lot too. That’s over 20 years ago.

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I’m finally receiving checks for 80% of my Ketamine infusions from Humana. Talk about having to jump through flaming hoops. The only way to submit information with the insurance companies is to fax it. Right now if I use the osmind app it screws things up. Same thing with the troches; they do not wanna pay for them. I am trying to figure out the Medicaid aspect of the other 20% of my infusions! If I get any information on and I will let you all know!

Congratulations to anyone that has got this accomplished it really is not very easy. I got a special authorization through Michael Bennett my senator here in Colorado. Finally after all these years I am getting some help for being shot. I was only nine years old ; so there is some heavy duty emotions and feelings around it all! It is good to be around people being proactive about getting better.

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I am also there, but my insurance is Medicare and Medicaid :sob:

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Humana is a PPO. I believe Medicare was involved in the decision. I hope you’re able to get some help! @KetKat

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I was kind of taken aback. Sort of came out of left field. Something must have happened. Not helpful.

I am confused. What happened? They changed their mind about covering the treatment?

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I’m writing about the contract Dr Brooks had us sign telling us he was opting out of Medicare.

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I learned last year that lots of insurance companies are not paying the doctors! Or if they do, it’s a microscopic payment that doesn’t help cover any overhead. This is the reason so many providers r not accepting medicare. Because medicare has been a huge culprit. It’s maddening. And none of it is Dr. Brooks fault. I am appalled that this entire time this has been happening to my care team and I had no idea! These companies need to pay the doctors. Period.

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Check with Humana…,it’s a PPO for Medicare. Since I got 80% coverage I am sure that someone else can accomplish it as well! My ketamine doctor will not deal with Medicare at all. Other than the letter stating I needed the therapy . That’s all you need to get started . The letter from your doctor and potentially a congress person to help you. You will have to do all of your own paperwork. I know this stuff is overwhelming and I just want to help. I had many bad days because of it.

Medicare is making it scary for doctors. That is why they are avoiding it. Medicare needs to get its act together and take care of us.

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What’s a PPO?