Aa
Aa
A
A
A
Close
572651 tn?1530999357

Insurance and MS - What is routinely covered....

Hi all,
I was looking for the ICD9 code for MS for some forms (#340 I believe) and came across this excellent  Aetna insurance  "Clinical Policy Bulletin: Multiple Sclerosis" - in clear language it explains what they consider routine coverage for MS.

www.aetna.com/cpb/medical/data/200_299/0264.html

If you know of other insurers that post a similar document please feel free to add it here.  

Be well,
Lulu
9 Responses
Sort by: Helpful Oldest Newest
1936411 tn?1333831849
Thanks, you guys! Lulu, I couldn't believe that I found a post from 2008 and I knew ALL the people who commented on the thread. You guys are O.G. ("original gangtsa"). That is a great idea to try to get in to a clinical trial that requires MRI's. I will definitely be on the lookout.

I talked to Shared Solutions and was told that my copay assistance should remain in effect, so that part is covered. I also talked to Aetna and got some info on the maximum they will pay  towards MRI's... It seemed pretty low to me... According to the person I spoke to, the max they will pay is $1,490 for a brain MRI with and without contrast, and less than $700 for a "back" MRI (whatever that means).

I remember seeing the bill for my diagnosis MRI of brain and spine with/without contrast, and it was over $9,900 dollars! I will be calling my neuro and the maybe the facility I have MRI's through to try to find out how much they will charge for an MRI when I'm covered through Aetna. I get the impression the same facility will charge different prices depending on what type of coverage an individual has. I don't mind paying for part of my MRI's, but I sure don't want to be blindsided with a $2,000 bill!

- Jane
Helpful - 0
572651 tn?1530999357
And I can't believe you found something like this from 2008 right after I was dx'd.  These archives here have a lot of valuable information if people just dig deep enough.
Helpful - 0
572651 tn?1530999357
Jane,, this is another good reason to try to hook up with one of the many great MS groups in Boston and do something research wise with them if possible - the costs of these MRIs are then covered.  

I'm currently doing the tysabri trial that has me in the 7T machine 3 times over a year.  They don't use the mri pics for clinical purposes but would notify my doctor if there is significant change over that time.  

Helpful - 0
Avatar universal
Jane- I have Aetna, but have only had one set of MRI's, so I'm not sure about the continuing ones.  I know that my first ones had to be split up as they would only pay for 2 at a time, so I had to do brain, cervical and then come back the following week for thoracic, lumbar.  Don't know if that helps, but I've had Aetna for a few years and have absolutely no problems with them paying for anything, including the $27,000 vials of Acthar Gel.

Good Luck!
Kristen
Helpful - 0
1936411 tn?1333831849
I'm about to switch from Blue Cross/Blue Shield to Aetna, so I've been researching Aetna insurance coverage. This old thread has a lot of great info (thanks, ladies!), but doesn't quite answer all my questions. One of my main concerns is MRI cost, since I will be getting at least one (and maybe more) MRI's to monitor disease progression over the next couple of years (I just started a DMD this past Feb).

I found the following Aetna policy doc online regarding coverage of MRI's: http://www.aetna.com/cpb/medical/data/200_299/0236.html

When I read it, I fear that only diagnostic MRI's are covered (unless MS qualifies as a "spinal malignancy"?). It doesn't seem to discuss MRI's for the purposes of monitoring MS disease progression or DMD effectiveness... so I'm not sure if those will be covered or not.

I will be calling Aetna to get more information, but wanted to see if there are any current Aetna members out there who can share their recent experiences. Regarding my DMD, I am on Copaxone and will be contacting Shared Solutions for more info (hopefully I can still get financial assistance to cover the majority of my copay and med cost won't be an issue).

Any input y'all have as I make this change would be much appreciated.

Hugs,
Jane
Helpful - 0
572651 tn?1530999357
thanks DV.  That makes for some very interesting reading.  For us who live south of the border hear things about your medical system setup but reading it in black and white helps to understand it better.

Be well,
Lulu
Helpful - 0
382218 tn?1341181487
For the Canadians, this link is to a overview of provincial government coverage for MS disease modifying therapies.  I can't recall if I posted this already in a previous thread.


www mssociety ca/en/research/pdf/drug-table-mar05.pdf


The Alberta info is out of date, as the max. co-pay per month is $30 (not $65) under the Blue Cross non-group plan.  For those in Alberta with additional coverage, say through an employer-based drug plan, the plans are linked and would typically result in zero co-pay.

This chart is dated 2003 so I've emailed the Society asking if there is an updated one.  If so, I will follow up with the info.  In the meantime I figured this is useful info, at least for the contact numbers for the various provincial insurance plans.

The Nunavut, the Yukon and the NWT are not covered in this document.  I am aware that they have Chronic Disease drug programs, but do not know the specifics.
Helpful - 0
572651 tn?1530999357
Shell,
did you look at that Aetna page yet?  I got really excited as I began to read it - it certainly demystifies how they look at MS treatment.  -Lulu
Helpful - 0
198419 tn?1360242356
Oh, Lu - this will be a great thread, and one I hope we can fill with routine MS coverage from multiple providers.  I'll do some digging and contribute.  You'd think it would be open public information.
Helpful - 0
Have an Answer?

You are reading content posted in the Multiple Sclerosis Community

Top Neurology Answerers
987762 tn?1671273328
Australia
5265383 tn?1669040108
ON
1756321 tn?1547095325
Queensland, Australia
1780921 tn?1499301793
Queen Creek, AZ
Learn About Top Answerers
Didn't find the answer you were looking for?
Ask a question
Popular Resources
Find out how beta-blocker eye drops show promising results for acute migraine relief.
In this special Missouri Medicine report, doctors examine advances in diagnosis and treatment of this devastating and costly neurodegenerative disease.
Here are 12 simple – and fun! – ways to boost your brainpower.
Discover some of the causes of dizziness and how to treat it.
Discover the common causes of headaches and how to treat headache pain.
Two of the largest studies on Alzheimer’s have yielded new clues about the disease