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Post Info TOPIC: Had Intacs, CK, and C3-R - Seeking reimbursement


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Date: Tue Nov 30 10:48 PM, 2010
Had Intacs, CK, and C3-R - Seeking reimbursement
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Hi everyone,

I am new here and have had Keratoconus for roughly 15 years.  Both of my eyes became contact lens intolerant in late July.  It was time for me to take a big step, as the idea of corneal transplant had been thrown around for about 10 years, but never sat right with me.

I had Intacs, CK, and C3-R done in late September with Dr. Boxer Wachler in LA and am seeing great results.

I am looking to get reimbursement from Kaiser - initially the claim for everything was denied.  I have appealed it and now have a conference call appeal meeting to have my case discussed and have a chance to speak briefly.

Does anyone have any experience with reimbursement from Kaiser for all or part of these procedures?  I had heard that most insurance companies reimburse/cover Intacs.

Warmest Regards and thank you in advance for your insight. :)


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Date: Wed Dec 1 3:06 AM, 2010
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Melissa, welcome !

May I ask what is you vision like now ?

Keep on at them about the insurance coverage, you should be covered for the intacs (no personal experience on this but its what I have heard also)

My very honest opinion is that non FDA approved treatments should be done at minimal cost, was it part of a study ? is it linked to a university ?

Bob

-- Edited by Bobby on Wednesday 1st of December 2010 03:10:27 AM

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Date: Wed Dec 1 3:33 AM, 2010
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Hi Bob - thanks for your reply and insight. :)

I am about 2 months post-op and have a pair of soft contacts that have me see approx. 20/60. Its not fabulous - but without these lenses, I am legally blind, so I am thankful.

As my eyes continue to flatten and the astigmatism improves, the vision will get better and I can get into a more permanent pair of contacts (could be a strong soft lens or a gas permeable).

The procedures weren't part of a study - the doctor that did them was so very down to earth and so was his entire team. He keeps a small, close-knit group around him.

I will plan to stay on the insurance for sure. Thanks for your support. :)

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Date: Wed Mar 9 2:02 PM, 2011
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Intacs should be reimbursed. It could take some persistence since you are handling the claim and not the doctor. I'm pretty certain the CK and C3-R procdedures will not be covered. I did not seek reimbursement for these two procedures. I believe the FDA considers them cosmetic. I liked Dr. BW and his staff. They had an employee suddenly leave some time ago, and I noticed staff changes the second time I was there. It could be nothing, but I'm always concerned when I see turnover in a company...especially, a small one. Dr. BW removed my upper intac segment, performed C3-R and CK on the worse of my two eyes. I think the procedures initially helped, but feel that those results seem to have faded...probably because of cell regeneration. Intacs should be a last resort, in my opinion. I've had a horrible time trying to find tolerable contacts.

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Date: Wed Mar 9 6:40 PM, 2011
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Thank you for sharing Ryan! You know, i was totally surprised i could not get my Intacs or anything reimbursed. I did my first submission of all my info, was declined, then I appealed, and was given the opportunity to state my case and any more info i had obtained to a team if Kaiser doctors, to have it denied again. Then, lastly, i did an IMR (independent medical review) where a comoany comes in as basically a 3rd party and looks at your case...and was denied again. I am at peace with it, its just a little sad, as bad as my eyes were, and Kaiser really only offering me the option of a transplant in both eyes. Some doctors are just so quick to think a transplant is the only option. :(. Really gad i had all the pocedures i did.

As for my intacs, i don't even feel mine. I hope you find some lenses that work for you. What type of lenses are you currently wearing?

Over the past 5 months my eyes have improved more and more. In the next few weeks i will be looking at a "more permanent" solution for my contacts. I amcurrently in just plain OTC soft lenses that have me see 20/40 in the right and 20/70ish in the left. Its leaps and bounds from where i was. :)

So glad Dr. brian was your doctor too. I wonder which member of his team left. It was a very small, close-knit group.

Sending you good vibes for your eyes. It can be a day to day or sometimes moment to moment disorder. Its always nice to be in like company with someone who is going thru the same thing. :)

-- Edited by Melissa on Wednesday 9th of March 2011 06:41:10 PM

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Date: Thu Mar 10 10:33 PM, 2011
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I can't recall the kind of contacts I wear, right now. They are soft lenses, though. If I think of them, I will let you know. I could not wear gas perms or spericals due to the irritation that they caused at my incision scar. I see fairly well in the contacts (around 20/25), but don't wear them all the time as my vision kinda fluctuates while wearing them. I would like to try softperms, but my current doctor hates them. My left eye is still pretty good, so I can get around in glasses. They used to have a different woman that the patients would initially consult with. Her name was Bari. If you know Jen, then she is the one that took over that position. There were also some changes with some of the other staff. I've only been there twice, so I don't know them those people by name. I'm still skeptical of some of the practices of Dr. BW, but I am glad I went to see him. Good luck!

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Date: Thu Mar 10 10:46 PM, 2011
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Cool that you mention soft perms. I wore them years ago before the making of them became as advsnced as it s today. Back then, i was not getting enough moisture thru the lenses and my poor eyes were just suffering so. I have heard great things about them and then a schleral (sp?) lens..its really large, so i have heard. Before i had all my procedures done with BBW, i was doing the piggyback method...i hope i won't see the days of that again. Man.

Good for you on your 20/25 - that is awesome.

Yes, Jen is sweet. Really genuine and thorough. BBW has a great team with him. Feel free to PM me with your thoughts on what you are/were skeptical about if you wanted to share. :)

Take care,
Melissa

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