Insurance

[bluebeara]

my question is did anyones insurance require a spinal tap? My insurance will not allow me to start treatment till I get one done I have had multiple MRI's and blood test my doc want to start treatment but the are making me go through more hoops:( Im pretty scared of a tap and dont understand why it was not done sooner if it was needed.

[Twinsmom06]

If your doc is comfortable with giving the Dx without the LP...I would not recomend getting the LP. The text does not come without risk and for me...I had a horrible experience. I agree with Shell...a letter from the neuro should overide this "standard" within your insurance.
Good luck to you...how frustrating!

[sllowe]

Hi Blue - It's pretty bad when insurance companies are telling the doctor how to dx an treat their patients. Especially for "clinical" diagnoses.

All that was said in regard to dx above is true. Positive LP it's not needed for diagnosis in many cases. You should already have had many blood tests, and imaging. It's because there are many mimics, and it's not an always easy dx to make.  But, if your doctor says you have MS, and orders your meds, then the doc should go head-to-head with insurance company.

There are checks and balances in place for good reason, but if your dxing doc is a neurologist, and he/she did not need/order the tap for further evidence, then this should not be happening.

A letter from your neuro to the insurance company is in order. Hope you can clear this up.
-shell

[doublevision1]

My experience with the LP was similar to others here, it was no big deal at all.  Barely felt the needle, it was more like just firm pressure.  

However I don't understand why your insurance company is requiring it.  What does that mean for you if it comes back normal,  which it very well could.   Does that mean they won't cover your DMD even though you do have MS?  It doesn't mean your neuro is wrong about your dx, provided other diagnositic criteria has been met, which it sounds like it has.  

Plus, as you are already dx'ed, putting you through the LP, even though there's no reason to get too worked up about it, is still putting you through an unnecessary procedure, and even mundane procedures like this carry some degree of risk.

I agree with those who encouraged you to ask your neuro to challenge them.  The inconsistency in the approaches of the multitude of health insurance companies  in the U.S. truly confounds me.   It is so much simpler in Canada.  Physicians order tests and treatment and there is no approval from a paper pushing insurance employee required in order to proceed.  I hate to hear how patients have to jump thruogh so many unnecessary hoops in your country.  The last thing anyone needs with they are newly dx'ed with a serious, chronic disease.  

Keep us posted; hopefully it won't take too long to sort this out as I'm sure you're anxious to get on with it!  

[maxthecat9196]

I didn't have much trouble with mine either.  I would recommend asking to have it done under fluoroscopy.  It did make me dizzy.  And the site takes a while to heal up. I For me the worst part was the tech who was supposed to take blood tests afterward- I was bruised for a week.  I have another one coming up next week.  

Tammy

[Lulu54]

The LP does not confirm or disprove a diagnosis of MS.  It is only used to support the other evidence (clinical exam and MRIs).  That your insurance would require an LP makes absolutely no sense and I would pursue that with the insurance company and also ask your doctor to intervene on your part.

For what its worth, I had absolutely no problem with my LP either.  The whole thought and name causes great fear and worry but for most, it isn't as bad as our imaginations make it out to be.

Lulu

[HVAC]

Most insurance wants proof of a diagnosis since the Disease Modifying Drugs cost over $2000 a month. I was sedated for my LP with IV Valium. I do not remember a thing.

Alex

[SarahL2491]

I'd still like to see it in writing, I would think your neuro could over rule them, much like they can request meds when ins. co's deny them 1st gime around.
If he doesn't think you need it, why go thru it........

[kwarendorf]

I don;t think it is a "requirement" for dx any longer. Sounds like your insurance CO thinks differently. I had an LP in September of this year.Like Jacksmom it was not a big deal, no headache or side effects of any kind. It showed oligoclonal bands and confirmed my dx.