Treatment Options > Radiation / Radiosurgery

Insurance Co. VS Radiosurgery

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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

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