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sickbadger8 05-29-2018 01:39 PM

balloon sinuplasty- insurance denied, claimed it is experimental
Dear All,

My insurance has denied balloon sinuplasty and claimed it is experimental.

Would you mind letting me know what your experience is with your insurance? any info will be appreciated.

I am trying to write an appeal and a friend who had been through the same process for a cancer treatment said that the more I can proved that the procedure is approved routinely , either with the same insurance carrier or other major insurance carrier, will be really helpful. Please help me!

And by the way, I am a commercial pilot by profession, that makes me very reluctant for any unnecesarily invasive procedure. Apart from having the license, pilots are required to pass aviation physical exam every year. Surgery will create a red flag, and complications can be career ending. This is why I feel strongly about going for the balloon, as originally recommended by my ent, rather than a surgery that they would pay for.

Insurance would pay for Functional endoscopic surgery but not for balloon sinuplasty. The doctor said what need to be done to open up the maxillary can be done with the balloon which is wayyy less invasive.

Thanks in advance for your help

yayagirl 05-30-2018 08:37 AM

Re: balloon sinuplasty- insurance denied, claimed it is experimental
Dear sickbadger,

I had the balloon sinuplasty for 'stuffed' swollen sinuses and while it may help some people, I can attest to the fact that it did nothing whatsoever for me, plus it was a hideous experience. The after pain was incredible, and even with following after care to a T, yes, I could breathe clearly for awhile, then in a couple of weeks my sinuses are back exactly the way they were before that horrid experience. I do believe that the procedure is experimental at best if not complete quackery.

I suggest that you not hold onto that as your only or best option. I think that powers that be at times are looking after us when we can't get access to some things.

I personally hope I remember and never go to an ENT again. If you have a lingering infection or a polyp or some such those can be dealt with by a general practitioner or regular surgeon.

sickbadger8 05-31-2018 07:32 AM

Re: balloon sinuplasty- insurance denied, claimed it is experimental

Thanks a lot for the feedback.

I personally would rather not have any procedure done up there unless I absolutely need to do it. This forum has been very helpful--I realize that part of our body (or maybe the whole entire body) is really complex. Too much messing around could do more harm than good, and worst, if you cut something off you can't grow it back.

I did not realize it hurt that bad or it did not even work long term for some people so that is good to know.

I am not sure what next. I would say getting culture, maybe sinus washout procedure and see if those work, otherwise I might have to try it out and see how it works for me. But no, definitely no full on surgery. I truly do not believe in that.

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