Ketamine helped my treatment resistant depression, now what?
January 10, 2017 11:40 AM   Subscribe

After trying EVERYTHING for over a decade to help my treatment resistant depression, I tried Ketamine infusions. They help, but they are expensive and inconvenient.

I went through an initial 6 infusions and improved more than I have with anything else (meds, etc). It wasn't life changing like it is for some, but I definitely felt hopeful and not terrified with anxiety 24/7. I could sleep and my workouts improved. There is no set amount of time to return for booster infusions after the initial 6, but most people seem to return every month or so for a booster. Two weeks after my initial 6, I felt anxious again and returned for a booster and felt better. It has been 2 weeks and I feel like I need to go back again. Obviously this is not sustainable.

I called the doctor and they recommend Nudexta to help stretch b/w infusions. I am looking into whether my insurance will cover it. My insurances have sucked since the healthcare reform (not a political statement, just a fact). The doc that gave me the infusions is calling a Psychiatrist that I've worked with to see if he'll prescribe it. Neither recommend nasal ketamine. It has to be IV

I don't know what to do. I have about 20k in the bank. I don't have any money after my bills every month. It costs $450 an infusion and the clinic is 2 hour drive each way. I am shot for the whole day of the treatment.

Logistically and financially it just isn't sustainable. I spoke to both doctors who do it in the tri-state area and they are both the same price.

Is there any way to get reimbursed? Do I just call my new insurance and speak to whoever answers the phone? Is it even worth trying? How else can I raise money or get free help? The drug itself isn't expensive, it is the cost of the doctor/clinic/anesthesiologist etc. I've heard of free trials, but I'm probably not eligible. Are there any programs or anything else that I can do to get help?

posted by kbbbo to Health & Fitness (3 answers total) 6 users marked this as a favorite
>Is it even worth trying?

It is *always* worth trying. Don't ask, don't get.

Before a phone call, spend a few minutes thinking about what you are trying to accomplish.
Organize the documents of your past treatment, so they are available during the call.
Make a small list, no more than 3 items, based on what you are trying to accomplish.
Based on your question, here's a list:

Ask about getting re-imbursed for past treatments.
Ask about it would take to get re-imbursed for future treatments.
Ask if there is any way the treatments can be covered.

Have pen and paper available during all phone calls.
Take notes during the call, and date them. Keep them in a folder, in order.

Additionally, talk to your doctors about nasal ketamine, and why they don't recommend it.
Push back, and mention that cost is an issue. Ask about sublingual ketamine, too.
posted by the Real Dan at 1:00 PM on January 10, 2017 [7 favorites]

Seconding the push to try the meds you can afford. Good luck, and I'm glad it's helping. This shouldn't be this hard.
posted by schadenfrau at 1:38 PM on January 10, 2017

You should definitely seek to have your insurance cover it. It may fall under a formulary exclusion, or be denied as not medically necessary because it is considered (by the insurance) to be experimental/ investigatory. You should have appeal rights under either situation depending on the type of insurance you have (through the aca, an employer, self-insured or fully-insured). It may take a lot of work to fight it, but would be worth it if you can get it covered.

your new insurance will not reimburse you for any treatment you received prior to the policies effective date though so keep that in mind.

If you have New York based insurance you can call:

Community Health Advocates
(888) 614-5400, Monday-Friday, 9 a.m. – 4 p.m.

It's the state's consumer assistance program under the ACA, and they can assist you with figuring this out and with appeals.

When calling your insurance, always get the representative's name and a reference number, and if you don't have it, ask for a copy of your policy contract, the document that describes the plans benefits and exclusions, it should be approx 100 pages. I always take what reps tell me with a huge grain of salt (they are underpaid and under-trained, particularly for more complex health questions). You should not hesitate to call several times to see if you can get different/new information.

Feel free to memail me if you have any questions.
posted by gnar_gnar at 6:37 AM on January 11, 2017 [1 favorite]

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