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Old 02-16-2013, 05:08 AM
  # 96 (permalink)  
Ananda
Member
 
Join Date: Nov 2007
Posts: 26,425
Fandy,

I don't understand exactly how this works...but my brother ran into a similar situation with his cancer treatement....

It is FDA approved (I think that's what it is called), so it isn't really trial in that respect. But it isn't an "accepted" choice within the insurance community.

Alchoholism and obviously cancer and other illnesses are very interesting in that just because it is beyond the original trial level, insurances can still say no.

When I went to way too many treatments, the insurance wouldn't pay anymore, and I sort of get it....they wanted something that was different than what was tried before...they determined that this treatement is "different" and therefore not a waste of funds. I actually don't like that they can make that decision, but it is clear to me that they do stop paying if they don't think the client is doing something different when it comes to alchoholism. And they don't have to accept "cutting edge" cancer treatments that don't have a very clear track record of making a difference.

My brother's treatment costs 14,000$ per shot with a 3-4 round series. His share is 1,400 per shot. The stress financially and emotionally for "causing a financial burden on the family" is tremendous. But we pull together and do it. It has extended his years of expected life by several years now.

This treatment for me is at a cost of 1,000 and I pay 300. Frankly it is less for me (expect to only do 3 shots...hopefully) and to the insurance the bottom line is their 2,100 is no more than a hospital bill for a "minor" pancreatits event or suicidal event...I guess it's win win. I hate that insurance gets to make the decision rather than a doctor on what is the next medically indicated thing...but that is how it is.

So short answer, even though they call it "trial", it's past the FDA trials...it's insurance acceptance of the treatment that makes it an approval of a "trial medicine". Trial as far as insurance goes LOL

I'll get the first shot next month after I get my tax return .... I'll worry about the next month the next month...the dr thinks if I get 3 or 4 months sober I can probably get "substantial time in recovery" and get myself out of this.

Nands
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