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CNN story about Aetna denying laser ablation treatment

I was trying to learn more about this case where Aetna is not allowing one of their customers to do laser ablation. Cara Pressman, the subject of the story, is trying to get her insurance company to let her do laser ablation surgery.

I'm about to have that done. The surgery is not being paid for by my insurance (United Healthcare). It is being paid for as part of a medical study sponsored by Medtronic, the company that makes the Visualase System which is used to perform the laser ablation. The study is called "Stereotactic Laser Ablation for Temporal Lobe Epilepsy (SLATE)". I have added a link below and would be happy to try to answer questions. I'm doing the surgery in the next three months. (FYI, I am just a patient and don't work for Visualase and am just discussing this, not advertising)

I hope that helps. I'm trying to understand the situation with insurance companies. What is their standard for them being willing to pay for a type of medical care? With the Visualase device, it says that it is "cleared by the U.S. FDA to be used in neurosurgery" but is considered an "investigational device" for people with drug resistant mesial temporal lobe epilepsy (MTLE). The FDA has not approved it for marketing as a treatment for epilepsy (again, that's why I'm trying to make it clear that I'm just a patient and not trying to sell this). Does the surgery have to be 'approved for marketing' before an insurance company will cover it? Is that usually the case?

I'm disappointed with the CNN story because it did not explain that the clinical trial would only include people 18-70 years old. Is she in a bad spot because they won't let her in the study because she is 15 years old and insurance companies don't pay for treatments that are not 'approved for marketing'? Or do insurance companies often cover treatments that aren't yet 'approved for marketing' and Aetna (and others) are just being cheap in this case?

PS Cara, if you're reading this I hope that things work out.

http://www.cnn.com/2017/12/11/health/aetna-surgery-denied-for-girl/index.html
http://www.medtronic.com/us-en/healthcare-professionals/products/neurological/laser-ablation/slate.html

Comments

It is being paid for as part

It is being paid for as part of a medical study sponsored by Medtronic, the company that makes the Visualase System which is used to perform the laser ablation.<<<< MEDICAL STUDIES are paid for by the companies that made the equipment. Just like the studies for medications that go on for years before they hit the market. Like the one that was started for glioblastoma in 2 colleges now is being worked in more. That will not be out for awhile. So if the surgery is in the testing stage then that might be why it is not being approved.

HI, this therapy is being

HI, this therapy is being used by epilepsy specialists all over the use, and it doesn't make sense that the insurance company deny it. The Epilepsy Foundation's Advocacy Department is constantly working with companies to ensure access to the right treatment for people with epilepsy. They are now trying to work with insurers around this issue too. Please call our 800 line with questions about this. The more personal experiences we can get, the better!Feel free to leave a note here too and thank you!https://www.epilepsy.com/make-difference/advocacy

I lived on the east coast

I lived on the east coast (home) between DC-MD-VA.  I moved to the west coast (Washington) one year ago.  For about 5 years, my Maryland neurologist recommended that I go through testing to see if I was a candidate for TAS.  I've been nervous about it.  I have MTLE and no medication has been successful in controlling my partial seizures.  I don't know if my insurance will cover it either.  Is it considered a "newer" procedure and/or if the insurance companies consider it as "elective" surgery?

Thank you very much for the

Thank you very much for the information and link.  I hope that everything goes well for you and will be looking out for your sharing the different tests that you will undergo along the way.  Where will you be undergoing the testing and surgery?

I lived on the east coast

I lived on the east coast (home) between DC-MD-VA.  I moved to the west coast (Washington) one year ago.  For about 5 years, my Maryland neurologist recommended that I go through testing to see if I was a candidate for TAS.  I've been nervous about it.  I have MTLE and no medication has been successful in controlling my partial seizures.  I don't know if my insurance will cover it either.  Is it considered a "newer" procedure and/or if the insurance companies consider it as "elective" surgery?

SB,I did the Visualase

SB,I did the Visualase surgery at the Johns Hopkins Hospital. I felt really comfortable working with the people there. So far things seem to be working out well

SB, Not sure if you saw 'just

SB, Not sure if you saw 'just_joe's answer but it is a study. Hopefully you are over 18 years old and qualify.

Who is your insurance carrier

Who is your insurance carrier and are you still seizure free?

Are you still seizure free?

Are you still seizure free?

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