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Posted By : Hope-Filled - 5/3/2017 3:45 AM
I was diagnosed with CRPS/RSD many years ago. I live outside Philadelphia. I used to go to Drexel for ketamine infusions and then switched to my doctor at Delaware Valley Pain and Spine Institute. They are wonderful.

They perform pain injections and use ketamine for anesthesia and also they charge out of pocket for outpatient infusions.

I was recently informed they are thinking about looking into having insurance cover infusions. This is after Drexel closed their ketamine program.

Have other people had ketamine infusions paid by insurance?
Also, if the practice does start accepting insurance, please let me know.




I had to remove the contact info listed in your post. Please read the forum rules located at the top on the right. Thanks

Post Edited By Moderator (straydog) : 5/3/2017 6:59:53 AM (GMT-6)


Posted By : straydog - 5/3/2017 7:03 AM
Hello & welcome to the Healing Well. We do have a member named Skeye that receives infusions for CRPS. I am assuming her insurance covers the expense, otherwise I feel certain she would have mentioned it. Have you checked with your insurance on this? The infusions have really helped her a great deal.

Hopefully she will be lurking & see your post & responds. In the meantime, I will see if she has an email listed & send her a note about this. I just checked & she does not have her email listed.

Please keep checking back. Take care.
Susie
Moderator in Chronic Pain & Psoriasis Forums

Post Edited (straydog) : 5/3/2017 7:21:57 AM (GMT-6)


Posted By : skeye - 5/3/2017 3:52 PM
Hi Hope,

As Susie said, I also get ketamine infusions for CRPS. I've been doing them for going on 2 yrs now, and they've been life changing for me.

My insurance covers my infusions MOST of the time. They don't pay for all of it, but they usually pay about $500 of the $1500 bill (I'm talking per day here), which is good enough for my doctor. However, for whatever reason, there were two times when my insurance did not pay, claiming that the treatments were both "medically un-necessary" and "experimental." We appealed and got them to drop the "medically un-necessary" claim, but we lost the appeal on the "experimental" claim. It was frustrating because all of the external reviewers essentially said "this person is an excellent candidate for ketamine infusions, and we have no doubt that these infusions have made a significant difference for this person when nothing else worked, but because there are no FDA approved trials proving the efficacy of this drug for CRPS, we have to side with the insurance company and deny coverage of this service."

I thought that after that, my insurance would no longer cover ANY of my infusions, and in fact, would probably go back in time and withdraw their payments on the infusions that they had covered previously. But so far, this does not seem to be the case. I've only had one set of infusions so far since receiving the results of the appeal (have another set coming up in a few weeks), but they covered those infusions no problem. And so far, I haven't heard anything about them withdrawing previous payments. So I have no idea why they denied those two infusions, but seem to cover all the rest (and I'm not going to ask nor complain!).

According to my doctor, most insurances seem to cover the infusions, including either (or?) Medicare and Medicaid. Apparently my insurance was one of the few that he has had problems with. But I'd suggest 1) talking to your insurance about coverage beforehand, and 2) talking to your doctor about what the out of pocket costs will be if insurance doesn't pay (my doctor discounts his services for patients who do not have insurance coverage, or whose insurance pays only a very small amount).

Of course, my experience is just with one doctor. And he is one of the very few that I know who accept insurance coverage of/bills insurance for ketamine infusions. Certainly all of the more commercialized "ketamine clinics" don't accept insurance, and I would never go to one not only because of the out of pocket cost, but because you're not getting personalized care -- you're just a number -- which is the total opposite of the way my doctor treats his patients. But if you want more/more generalized information, you might also talk to the folks at RSDSA (rsdsa.org), as they might be able to provide you with more information/insight about typical insurance coverage of services like ketamine infusions.

Hope this helps.

Skeye

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