Although I am currently in remission, if /when it comes back again, as bad or worse as it was, I will need to look into having the MVD surgery.
I am familiar with Dr Casey, and even heard him speak at a TN support group meeting once. And there is another surgeon here in Chicago - Dr Gail Rousseau - who has done hundreds of MVDs.
The problem is that my insurance is basically an HMO - it is through my wife's employer, which is a medical group itself. The coverage is great when you see doctors inside the program, but very expensive otherwise.
Regardless, while so many people recommend Dr Casey, I have wondered how I would ever get my insurance to cover surgery done by a surgeon in another state, who is not even close to being a member physician on our insurance plan.
Do you mind me asking how others have dealt with this, if you have? My gut tells me that my insurance company will tell me first and foremost to have the surgery done by a neurosurgeon at one of the few local hospitals that take our insurance. I doubt that any of them have prominent MVD surgeons.
I suppose I could always go to Dr Casey on my own, but MVD surgery without insurance would probably cost me about $100K or something, right? I am just guessing - I have no idea.
Anyhow - if you went to Dr Casey for MVD, how did you convince your insurance company to let you have him do the surgery?
I did not have surgery with Dr. Casey, I had both my MVDS with another TN expert. He was out of state, and out of my of insurance network. My insurance approved the surgeries, and never questioned my leaving the state. As it was out of network, I had a very high deductible to satisfy before the insurance company would pay anything. The good news is , it is my surgeons policy NOT to co-bill patients. This essentially means they accept whatever the insurance company pays them, and will not bill me for the difference. The hospital was in network, so that was no issue for me.
I had four procedures with this doctor last year, and basically just paid him my out of network deductible.
Best of luck,
Christine
the first step would be to contact the insurance company i guess. my neurologist recommended the surgery and the insurance company sent me a list of dr in the group. one was on the list here so i used him and it worked!. get your list and contact all of them and ask, point blank, how many have they done and the what the outcomes were.
I went out of state last year to have my MVD performed by Dr. Casey (on month 8 now and med and pain free!!). I have a PPO and fortunately, Dr. Casey was on my plan and it didn't matter that I went out of state. I did call my insurance company multiple times though during the process just be be sure. Dr. Casey's office is very accustomed to handling patients out of state. I think that most of his patients to travel to see him. He does accept a ton of different insurance plans, which I think he does to be available to all as much as he can. He is passionate about helping TN patients. I would definitely contact your insurance company. I would imagine in the case of rare diseases and finding an experienced surgeon, there are exceptions that can be made.
I'm having trouble with my insurance. The network doctors have either refused to treat me because of the nature of my TN(botched os) or they don't treat trigeminal neuralgia. Tomorrow I will get a call from my regular GP who is finding me a neurologist in my network. The insurance company didn't help me at all. Once I see the neurologist they will refer me to a neurologists who treats TN (any where in the US). The insurance company will HAVE give me a waiver once I am referred to the neurologists who treats TN successfully. If the doctors in your network don't specialize in TN treatments I would suggest that you get a waiver because their network doctors are not qualified to treat your condition. It's a lengthy process. I was just diagnosed with TN on the 13th of May. My TN is from oral surgery. It's my understanding that it is treated completely differently when a botched oral surgery causes TN. Good luck.
Most insurance companies have a member ombudsman or patient representatives. If the company is giving you grief about going out of state, you can remind the ombudsman that TN is a rare disorder. Many neurosurgeons will never see a case in 30 years of practice. MVD is an operation which not just "anybody" can do effectively without specific training in the procedure. To demand that you use a physician in-network who doesn't have that training plus considerable experience exposes the company to a substantial financial risk in long term complications from surgery, and YOU to substantial health risk in a botched procedure.
In short, kick ass and take names. Don't take "no" for an answer. And start shopping for a better insurance company under Obamacare.