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What should/can I do in this situation?

I was approved for the DBS procedure by my primary insurance (a large national company), however they denied inpatient status for the 2nd phase surgery. My secondary insurance,Tricare covers DBS when it's for chronic pain, and they have it as an inpatient status, however when they are a secondary they use the guidelines set by the primary. I'd like to see if the working group that creates insurance guidelines would like to undergo surgery for 3+ hours having holes drilled in their head and leads inserted in their brain and then ride 3+ hours back to home? I sorta doubt it!

Do I have any options?

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Correct me if I am wrong, is the second phase were the install the battery pack?

 

I would file an appeal and fight for it.

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My leads were placed, and it was mandatory by my surgeon you will be in ICU for at least 12 hours after surgery.

 

For the "battery" that was done a week later as outpatient.

 

I really do not expect your insurance company to send you home the day of brain surgery. Just nuts.   For family,

I would recommend having a hotel close by.  My surgery was planned to be 1PM to 5 PM.  In reality it wa 2PM until 8PM,

for my wife by the time she left at 9PM, it was much easier to have the hotel 5 minutes away so she could sleep and be

close "just in case".

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Phase 1 is placement of the bone markers and a detailed MRI of the brain. There is a week between each surgery. Phase 1 & 3 are both done outpatient status.

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Thanks for the correction. Yeah, I recommend an appeal. Your surgeon and Neurologist should be able to assist you with this. I cant see them being comfortable with sending you home after the lead placement.

 

Hope it all works out for you.

 

Blessings

Adam

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Insurance approved of Stage II after my surgeon and I wrote appeals.

Happy Thanksgiving

Great to hear! I am happy for you.  Now you have a great reason to celebrate Thanksgiving

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I only have 2 stages for surgery. 

 

1. Both leads installed - overnight hospital stay ( I heard maybe 2 days)

2. 1 week later battery installed outpatient.

 

One month later, I get my first program from my MDS.

1 week after my first programming, I get another appointment with my MDS to possibly tweak settings more.

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Scott -- great news.

 

My insurance company always likes denying request. Deny. Deny. Approve.   They hope the doc requesting what ever goes away (they save money).

 

With follow up CT Scans for lung cancer, they do just that to me.  My Pulmonary doc is old and wise. He knows the routine, so explains "He is working, He is a well paid Engineer, if cancer gets him his spouse will sue for $20 Million and I'll write a letter explaining why you are at fault!" Approved!

 

Yes, it sucks... but sadly is part of the game. 

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