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Posted by Bruce on September 18, 2000 at 21:31:31:

In Reply to: Re: Will medicare pay for STN surgery? posted by Betty H. on September 18, 2000 at 16:16:46:

: : : : : 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
: : ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
: : Hi ya Bruce-
: : This is from Karen, who had her GPsurgery in Jan 98 and STN for other side in Jan. "Now I have upcoming surgery in January. I understand it is common practice for Medicare to pay for DBS now for surgeries done in Kansas. Dr. Pahwa told me this." If you don't have to put money out front, have the surgery at KU in Jan. and have faith that it will all work out. There's been a reason why you've delayed until now. Now is the time! You have a friend on this side (Me and Jay) who can lend support as much as you need while you're here with your caretakers Bob and his wife, Vida(?) Believe me, from someone who has had such a great experience, I'd hate to see you throw in the towel now! Maybe you'll run into Karen while you're at it. I know Dr. Pahwa was going to use me as the poster girl for STN for a while. I may have to lose some weight; can't look TOO healthy!I will have two spare bedrooms by Jan,. if you all want a free place to stay; coffee or green tea, lots of fiber and distilled water, bran muffins with raisons and applesauce, and just lots of great food and companionship. By Jan, I may have a PD group organized here that can offer shelter, meals, great friends and share positive attitudes. There are so many groups who will sponsor you in KC, too, I just bet!! (Tell them you know Ali or Michael and you'd be in!!) Just tell them one of the space cowboys needs a reservation. I WILL come over when you go thru this, I promise. I show up when they least expect it (and then they expect jumping jacks and smiles, and clearly voiced opinions, too.)
: : Come on down, Bruce! It'll be like being at home, only better!! (we have trees!) The same would go for any of the rest of you getting your head filed with these wonderful electrons. If you never got to do an LSD trip in the 60s, this will be like the one they had in cacoon. It's something else and worthy to be experienced. I think they call it euphoria, a common afterglow experienced by we people with holes in our heads! It's better than a Rocky Mountain High (Lawrence has a Mt. Oriad?) It's just better! Dr. John O. likes poetry, so bring your writings to share. How's this for inspiration: "What I feel impatience churning inside me I will remember that things are more enjoyable when they happen at a slower pace. Instead of hurrying I will take time to enjoy. (You know you're middle-aged when you feel your corns more than your oats.) I bellieve in you, Bruce!^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^6^^^^^^^^^^^^^^^^^6^^^^^^^^^^^^^^^^^^6^^^^^^^
: : Carole^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^9^^^^^^^^^^^^^^^9^^^^^^^^^^^^^9^^^^^^^^^^^^^

: Bruce,
: GO for it! With this group on your side, praying for you and cheering you on, you've got it made. There are so many positive people out there with positive feelings. Have faith, we all wish you well.
: Betty H.

Thanks for the support. You all are the best. I am calm and cool now, since I made the call to Dr. Hubble at Ohio State to refer me to KU. I don't have many close relatives, but my sister's one and only son will drive up to KU med center from Texas. Would you believe my nephew and I grew up in Kansas. Their was something interesting when I looked at the references for the government manual that revised the coverage. Two of them were from my doctor, Dr. Hubble, and one reference was from Dr. Kohler at KU. I just came from the HCFa government web site and they quoted from the same, exact manual CIM 35-20 and absolutely contradicted what I had read from the AMA web site. They stated that any service that is experimental is precluded from payment from medicare. I sent them an e-mail, but I have never seen anything so condusing. Their may be a couple of feet of snow on the ground when the time comes up, but I have a great driver and he has a new full sized four wheel drive pickup and I don't think there is very many things that would bother him. This $65,000 price for the surgery is a lttle more than I can afford, but at least, I downloaded the info. stating the surgery was covered by medicare. So I am commited to go for it. I was told they take four days to evaluate me for the surgery. It is comforting to know I won't be the first patient having the surgery (OSU) and to have a more experiwnced surgeon. Didn't you say Carole that the KU neurosurgeon had it down to five hours?

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