So thanks to this wonderful group I was led to doctors who diagnosed with bilateral severe jugular compression (Costantino, Liu, and Annino) I was trying to get surgery with Costantino but my insurance battle has been going on since June and I’ve received 3 denials. I know no one has probably had surgery with both Dr. Costantino and Dr. Liu but it’s really hard to decide between the two. Costantino didn’t want to do a venogram as the risks outweighed the benefits as I have a history of DVTs etc. If I go with Liu, I will need to get the angiogram and venogram. I just don’t think I’ll be able to get my insurance to approve surgery with Costantino, Aetna does not like the billing codes he uses and they consider this surgery experimental. I’m not sure what I’m looking for here, I’m just in a hard place.
@kiwi I’m sorry to hear that your insurance is getting in the way of your choice of surgeons. When my insurance (Blue Shield of CA) denied my surgeries with Dr. Nakaji, I worked with the State Board of Insurance Regulators who helped me get BS to pay. Maybe you could look into getting help from your state board? Did your insurance approve Dr. Liu? If so, do you know what codes he uses? perhaps Dr. Costantino’s office would be willing to bill it out under different codes?
My ICD 10 diagnostic codes (I had bilateral VES) were G93.2, M89.8X8 and the procedure codes, CPT, were 61605, 61590, 61781 and 69990 for the first surgery and 3872, 61781 and 69990 for the second. The surgical plans were the same for both surgeries but they used different codes so there is clearly some flexibility on the billing part in how they want to bill it out. hope that helps.
I’m sorry @kiwi that you’re struggling with these doctors and your insurance! I can see that you don’t want the extra testing done for Dr Lui with your medical history, it’s frustrating when doctors won’t consider patients without it, although to be fair I guess they want to be sure that everything is checked before surgery, that the surgery is definitely necessary and don’t want any nasty surprises, so that in a way is reassuring… I think others have had issues with Dr Costantino’s office & insurance approval, if you do want to go ahead I don’t know if the info in these discussions is at all useful:
I’m asking for my eagle syndrome familys help - General - Living with Eagle
Update …final appeal - General - Living with Eagle
Also @Isaiah_40_31 has said this ‘Health insurance companies have patient advocates on staff who are there to help patients with appeals to get coverage for non-covered medical care especially for rare illnesses or syndromes.’ So if you haven’t already tried this, maybe speak to your company and ask to speak to their advocate?