Health Organization for Pudendal Education

Seven years ago, Dr. Michael Hibner did surgery on me and I still am in tremendous pain. I had been in pain for 40 years before the surgery and today he said that the nerve had been trapped for so long, I had developed CRPS or an overly sensitive nerve that reacts wildly to even an injection. So he is sending me to have ketamine infusions.

Trouble with that is that insurance won't cover it and it costs about $800 an infusion. I have to have ten of those and there is no guarantee that it will work! Yikes!

Some people have been successful getting their insurance to pay for ketamine because Medicare covers it. You have nothing to loose by calling your insurance company and finding out what you need to do to appeal their decision since Medicare pays for it. You will need to work your way up the chain of command because the you need someone higher up in the insurance company that really makes these decisions. No guarantees but it is worth a try.

I have medicare and I was told by the clinic that they wouldn't cover it. But now I will call them myself, thank you sooo much!

I also heard similar situation in the clinic, with argument of insurance coverage. Infusion research provide mixed stats for success All the best!!

Tiny Dancer2, I have plain Medicare, not an Advantage Plan and they cover my ketamine infusions at 80% of reasonable and customary cost and I pay the other 20%. They have paid for my infusions the last 5 years so I know plain Medicare covers it. Some of the Medicate Advantage Plans may not.

nyt wrote:Tiny Dancer2, I have plain Medicare, not an Advantage Plan and they cover my ketamine infusions at 80% of reasonable and customary cost and I pay the other 20%. They have paid for my infusions the last 5 years so I know plain Medicare covers it. Some of the Medicate Advantage Plans may not.

How did it go?

Medicare pays for my IV ketamine at 80% and I have been on it since 2011. My medigap policy pays the remaining 20% and if they don't I challenge them on appeal using a letter of medical necessity and the fact that nothing else worked for severe pudendal nerve pain. The ketamine has been a life saver for me and I can tell you that it is rough at first while your brain adjusts to the medication but after a while things get better and your pelvic pain could subside to something much more tolerable. I started writing about my Ketamine experience on this site many years ago and i try to drop in from time to time to see if anyone else has had good luck with Ketamine. I'm seeing now that Ketamine is being used to treat all sorts of neurological conditions and Rheumatoid A and PTSD and drug resistant depression. Check out Dr Levine's clinics in NY and you can see that he is having great success administering Ketamine to patients who have lost hope and get 0 relief from antidepressants. Hang in there and never give up HOPE!

TCB

TCB,

That's great that ketamine has worked so well for you. What is your dose? That's great that medicare and your insurance are covering it all. Thanks for the info on the NY clinic!

April

Keep us posted how the ketamine treatment goes.

Did you not have any relief from surgery?

I tried ketamine and it was a bad mistake. It did not work and made me sick for a week afterward.