Over 120 different insurance companies and plans have reimbursed at least one case of vagus nerve therapy for depression. Reimbursement decisions continue to be made on a case-by-case basis. However is it important to note that 127 different payers have reimbursed VNS Therapy for at least case of treatment-resistant depression. These include: Eight Aetnas Humana Medicare Medicaid Cigna Twenty-eight Blue Cross/Blue Shields Cigna United Healthcare Alliance Insurance An increasing percentage of approvals are occurring upon the initial request and so far 100% of rulings by third party appeals boards have overturned denials. The message here is to never give-up and strictly follow the advice by Consumer Reports in the next section, your Cyberonics Case Manager and The Patient Advocate Foundation. Consumer Reports-How to Appeal Denial of Care According to the September 2005 issue of Consumer Reports, 43 states and the District of Columbia have a review process that allows patients to appeal denials of care. You must first take your case to your HMO or PPO. If it rejects your claim, you can appeal to an independent panel that is sponsored by the state. Then, you must strictly follow the correct steps. Follow the proper procedures. To qualify for a hearing, your dispute must usually involve medical necessity; that is, you or your doctor thinks that a particular treatment is essential for your health. You have a limited amount of time to file your appeal, which may be as little as 30 days in some states. If a delay in treatment would jeopardize your life or health, states provide for expedited review, usually within 3 or 4 days. Don't skip steps. A 2004 study by Consumers Union's Center for Consumer Health Choices and the Kaiser Family Foundation found that patients are too often making mistakes appealing their disputes. For example, patients did not complete the appeal at their managed-care organization before turning to independent review. States also told Consumer Reports States that patients frequently did not provide sufficient documentation of their dispute to go forward with the review. Consumers must show their medical records and proof that the procedure in question is medically necessary and not experimental. VNS is not experimental. It is FDA approved as an adjunctive treatment for chronic depression Learn your state's rules. To figure out if you are eligible for external review in your state, consult 'Consumer Guide to Handling Disputes with Your Employer or Private Health Plan,' available free from the Center and Kaiser at http://www.kff.org/consumerguide and http://www.ConsumersUnion.org/health/hmo-review |
