u/cmehigh

An issue has arisen from a routine test my primary care doctor ordered due to my age. She ordered a routine bone density test. I called my insurance company to check on coverage and was told after being shuffled to multiple folks and a lot of phone time that a routine dexa scan was 100% covered and I would pay nothing. So I scheduled the test at an in network covered imaging center. Had the test and went home. 

Several weeks later I received a bill from the center and they say I owe them $130. 34. Really? For what? I then spent hours calling various billing departments and my doctor's office sends me the code they sent over on the order to the imaging center which shows they ordered a routine test. I was able to get the billing dept. where the test was done to do a review and find out why I was charged for a diagnostic instead of routine test. Several weeks later, I receive another bill where it states that the review found that it was a diagnostic test. I also in the meantime receive a bill from a separate Radiological Group representing the doctors who read the test who I was unaware are NOT part of the Center and I owe THEM money too! And now I see on their more specific bill, that there were two codes, one for routine AND one for diagnostic both billed to me.

I call the center again today and was informed that if the test shows a result and there is a diagnosis of any kind then the test becomes diagnostic and they bill my insurance, which won't cover it other than an adjustment and I have to pay the rest for my deductible. I had a result in a few bones of mild osteopenia (normal for women in my age group) and because I had a routine test that actually showed a result (I'm a scientist all tests show a result of some kind) I now have to pay for the test and the doctor's time and expertise.

I had promised in another thread to post about my preoperative visit to the neurosurgeon after being approved by the SetPoint Medical specialist and the Rheumatologist near Chicago who was part of the original studies. I had a good visit with the surgeon, and he is also recommending the device for me if I choose to go forward. I had originally contacted the SetPoint company months ago since most DMARDS have failed me, and the rest had such severe side effects I had to go off of them. I am not a candidate for biologics as I am a melanoma survivor, and it is likely the biologics would give me lymphoma. I need cancer again like I need a hole in the head.

The SetPoint Medical company allows you to make an online appointment time for a phone consultation, which went really well, the representative asked me questions about my health, situation, and what drugs have failed me. They then recommended me for further investigation with a rheumatologist who had participated in the original study before it became FDA approved. Out of 16 patients that received the device in her office, 60 - 70% had positive measurable effects within a year, and some are in complete remission. Most are off their RA drugs entirely, others have been able to drop their dosages or one of their several drugs. Overall most are seeing a positive effect. Two, in severe disease, did not have a good measureable outcome. All of the patients chosed for the study were not responding to DMARDS and at least one biologic had failed them as well. Most had pretty severe disease.

The device contains a rechargeable battery and lasts for 10 years. It is scheduled to electrically stimulate your vagus nerve for one minute every 24 hours, during the night so you are not aware of it. The neurosurgeon says on average the surgery takes about an hour, but had just done one a few days before that took 24 minutes. Once the device is placed, you wait to heal for two weeks, then visit the rheumatologist to have the device activated. Most people then start seeing a positivve effect within the first month, some a little later.

The device small (size of a black bean) is removable, and in ten years when the battery dies, can be surgically replaced. The device is planted around your left vagus nerve. A few people have reported some hoarseness afterward, but with or without medical aid that has resolved for those patients.

The device is only offered in four or five sites around the US, I happen to live near enough (several hour drive) to this site and hospital complex.

The biggest issue now is my BCBS health insurance who refuse to talk to any doctors doing this procedure, but I am going on Medicare part B and that does cover it, unlike my work provided one. Once I sign up next week, I will provide the surgeon with that information and we will move forward.

Happy to answer any questions to the best of my ability.