Insurance Denied - Any suggestions on Insurance Carriers That do PINS?

Good day. I am seeking insurance information to see if anyone has had their stim implantation for TN II/Atypical Facial Pain covered by an insurance plan.

I was just turned down for a percutaneous implantation of neurostimulator electrode array by a Regence Blue Cross because it is "experimental;" however, I do know from reading these boards that some patients have had this procedure covered. I work for a small business and we wouldn't have a cadillac plan next year.

Any advice on appealing the decision also appreciated.

Thank you, -kr

When I visited my neuro surgeon Dr. Konstantin Slavin of University of Illinois Medical- he told me the steps I had to do to get insurance approval, 1. was the meds, (none worked for me) 2. Was a nerve block ( which I did and made me worse) and then insurance would approve with his recommendation as the "last" resort so, my first meeting with him was July 2011, and had approval for stim in October 2011, had trial done in November 2011 and final December 2011. I have Anthem Blue Cross and the neurologist insurance department handled getting all the approvals for me, the trial and the final I hope I can say on this board was in the neighborhood of over $ 125,000.00 just to give you an idea, feel free to ask me any questions I will be happy to elaborate, however the neurosurgeon should be able to direct you on the steps you need to take to get the approval, it is a life saver to say the least......

Thanks for response. I also want to know if it is working and worth it. I currently wear the external TENS 3000 stim unit and while I don't get pain relief, per se, it is distracting enough to warrent it's use.

YESSSSSSS with a good programmer it works, that is the key to this without a good programmer it is frustrating I have worked with 4 locals reps and best progammer is 5 hours away so I have to make the trip to get to the good programmer that understands "facial stims" no local reps work on facial stims as no neurosurgeons do them around me so that has been the only distraction I just went back to work 3 weeks ago after 3 years in the BED and besides taking over the counter tylenol or advil I am med free no more lyrica tegretol,amitrip,gaba for me!!!!! whoo hoo

Cleo said:

Kwebster- Is it working?

baxter8it said:

Thanks for response. I also want to know if it is working and worth it. I currently wear the external TENS 3000 stim unit and while I don't get pain relief, per se, it is distracting enough to warrent it's use.

I am not familiar with the external tens 3000 unit at all, have not heard or read up on it, but the PNS has been a miracle for me!!!!!!!! besides what i stated earlier about getting a good programmer that has been the only problem for me, I have to travel to get to a programmer no one in my area gets our pain, but that is my only complaint, I am med free and back to work and visiting my daughter at college and planning vacations etc etc and getting back to my life am so grateful and thankful I had this done Dr. Konstantin Slavin University of Illinois is the BEST neurosurgeon I have ever met!!!!!!! will answer any questions you want know

Hi THAT IS AWESOME!!! Did you have atypical Facial Pain also? I feel like this is my story, too. Can you walk for exercise with the implant pack? -kr

Mine was considered aytpical and neuropathic, also mine was in the lower V3 area which is supposed to be the hardest to get pain relief with the PNS, the stimulator is in my jaw with the wires running behind my ear and down to the battery pack that is in my chest all are inside of my body so you dont see except the battery pack in my chest, I had lost alot of weight not being able to eat (chew) so mostly liquids for me for 3 years, so my battery shows just because I had no weight there and it is just below my collarbone, and once you have healed about 6 to 8 weeks you are able to resume anything you want, the 6 to 8 weeks is really how long it takes to have everything scarred over so your stimulator doesnt move around so once you are through that kinda time, life is 100 percent better. 6 months ago, I was honestly getting my affairs in order to end this life, (dont think I would have done it but it was only thing I could think of to stop living in pain)..... Keep me posted, I will read up on what you currently have and see how it compares....

I had my placement of the stimulator in November 2012. I love it for the pain I had in V1, but doesn’t do much for nose or teeth area. The Neurosurgeon actually drew the mapping of the wires right on my face preop so we could discuss it. I have 3 wires. One about a cm above my eye brow, one below my eye and one that runs to the corner of my mouth. It works fantastic for my eye and could count on one hand the number of days I haven’t been able to control the pain in my eye, the wires actually give coverage across my eyeball because wires 1&2 interact with each other. Wire #3 was very disappointing however. It was supposed to extend across my upper lip. He said he had to pull it back because the tissue there was too thin and felt that over time it would wear through. That wire does NOT help my teeth or nose. I am glad I got the placement however, I am still on high dose meds because of v2. I am completely off narcotics though and have been well enough to work part time. My eye was the worse, so painful and distracting. My battery is fairly visible and I am not an extremely small person. I would suggest the rechargeable battery because it is supposed to last 5 years, and the not rechargeable one last only 18mo-2years. I started back jogging about 12 weeks after the placement and have had some swelling and tightness of the battery area and the wires going up my neck. Surgeon said nothing to worry about as long as the stimulation feels the same, which it does. He suggested a super ssupportive no movement sports bra, and now, I’m fine. I hope my experience is somewhat helpful to you. Good Luck. Oh!! I have type II…

I had absolutely NO problems getting insurance to pay. But, I had already had an unsuccessful MVD and different kinds of nerve blocks. I have Medical Mutual insurance. The secretary at the Neurosurgeon office actually did all the writing of letters for me. All I had to do was wait. It only took about a week to get approval for the trial placement and then had to submit another request for the permanent placement which took another week. I know I am blessed, but, appeal your insurance and be sure to include all past procedures you tried and that they failed.

agree with all Lisa26 said, Neurosurgeons office did all paperwork for me as well, my trial was 11/2011 and final was 1 week later 12/6/2011.

baxter8it sent you a friend request so you could look at my page, and see pics of surgery also posted a couple from now 4 months post op!!!!