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Posted by Bruce on September 17, 2000 at 13:35:28:

In Reply to: Re: Will medicare pay for STN surgery? posted by Debbie on September 17, 2000 at 10:32:28:

: : I have spent many hours trying to determine if medicare will pay for the STN surgery and I am totally frustrated at all the conflicting info I have located. The consesus seems to be FDA will approve the procedure in Jan. Then the question is does it mean that medicare will automatically will pay for it. The rep. at Kansas U. tells me they are approved by medicare, but I have searched and searched and could find no evidence of medicare coverage. More than one person has told me in there opinion every state should all be approved or all not approved and that sounds logical to me. One more article I discovered that was written by Dr. Pahwa, the neurologist who will be the first doctor at Kansas U. to determine if you qualify for the surgery. He said "insurance coverage will be more difficult to obtain because the surgery is stil experimental until the FDA gives full approval. So who does a simple country boy like me believe? Frankly, I am getting tempted to cancel the whole thing. Any comments would be appreciated. Bruce

: I am sorry you are having to go through this turmoil. I have some experience in Medicare reimbursement and may be able help you out. Medicare is one of the most difficult programs to work with when it comes to coverage issues because their guidleines are so "grey". I need to know what state you live in if it is not Kansas. Also, for a major surgery like this which is partly investigational (partly because the device used has already been approved for Thalamic Stimulation), KUMC would most likely get authorization from your home state Medicare (it is considered Out-Of-State Medicare by Kansas), so I am not sure why they have been unable to tell you point blank whether it has been approved for you or not. So let me know where you live and see if we can figure this out.

Debbie, After many more hours of searching, I found a web site sponsered by the AMA and I also found the medicare policy on DBS surgery. They have very specific guidelines that must be followed and documented and if it was documented correctly medicare will cover it, but they won't cover it if the hospital doesn't document everything correctly. So Googy, and others are correct in saying their is a national policy, but I still don't understand why so many people I have talked to are still waiting for FDA approval. You are correct that the device has full FDA approval. So it seems to look like I won't know for sure if medicare will approve it until after the surgery. Thanks for the help. Bruce

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