**UPDATE!**  Although I don't have a solution to my problem of my insurance company not wanting to pay for the replacement of my malfunctioning Vagus Nerve Stimulator yet, I do have some progress. My p-doc is currently compiling a letter to include with my own to my elected officials and to the Insurance Commissioner which includes a timeline of the clinical trials, FDA approval and other vital data about the VNS, along with the facts surrounding the entire situation. There's no guarantee of success, but this is progress.

If anyone has input or advice as to what my letter should (or should not!) say, by all means, PLEASE drop me a line! I'm open to all suggestions, thoughts,  and comments. And if you're an elected official yourself, I'd like to hear from you as well. Wish me luck!

Tags: Vagus Nerve Stimulator VNS Insurance TRD Treatment Resistant Denial Remissi

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I was diagnosed with depression 22 years ago and have tried nearly every medication and treatment under the sun with either limited or no success, thus resulting in being labeled as having Treatment Resistant Depression (TRD). I was at the end of my proverbial rope when, in late 2005, the FDA approved the use of a pacemaker-like device called a Vagus Nerve Stimulator (VNS) for Treatment Resistant Depression and Bipolar Disorder. It has been used for medically refractory Epilepsy since 1997 with much success. Just Google "Out of the Black Hole" - it's a book written by one of the patients who participated in the clinical trials - he had severe depression and with the help of the VNS, he was able to achieve full remission from the disease. He provides a thorough explanation of the device and the entire process.

In January 2006, I was implanted with my VNS. Every 5 minutes for 30 seconds, the device comes on and sends an electrical pulse to my brain through my left vagus nerve. The vagus nerve is basically responsible for things in the deep limbic system (bear with me, I'm not a doctor) such as mood, appetite, sex drive, sleep, etc.  Within 3 months, I began to feel a small improvement in my mood and sleep habits. Then, with each passing day, I felt a little better and eventually, for the first time since I was 15 years old, I was able to taper off all but one of 7 medications I was taking, I lost over 50 pounds without trying, things started to look brighter, smell stronger, sound louder and my family even said that I had a different look in my eyes. I was in remission for a year and a half.

Then, my world fell apart. I began to have familiar tired feelings. I started to experience insomnia again. I went to see my psychiatrist, told him of my symptoms, so he interrogated my VNS. The report wasn't good. It showed the device had a high impedance...an eletrical malfunction. It had to be shut off immediately and it had to be replaced. I begged him not to turn it off but the manufacturer of the device (Cyberonics) gave him specific instructions to turn it off for my safety (perhaps it was to protect themselves - who knows). Although I had the fight of my life on my hands when it was originally implanted with my health insurance company, they did pay for it, so I saw no reason why they wouldn't this time.

Well....

They didn't exactly say no, however, they didn't say yes, either. I received a letter from them after the surgeon sought pre-authorization stating that I should have the old VNS explanted and the new one implanted, submit the claim, THEN they would make a determination as to whether or not they would pay, but they would NOT pre-authorize the procedure. Of course, neither the surgeon nor the hospital would have any part of this, and rightfully so. I have begged and pleaded and argued my point and done everything I can think of to convince Blue Cross Blue Shield of Florida to pay.

Meanwhile, I have fallen back into that shell of a useless, non-functioning human that I SWORE I would never be again, taking 5 medications a day that don't work very well, I lost my job, and most of all, I lost myself. The device has been off for about 9 months.

My point? I'm asking for advice and help. If anyone out there has figured out how to get their insurance company to pay for the device or if you have any ideas, I'm interested.  If you are a physician, or a patient, or researcher, or employee of an insurance company or of Cyberonics (seriously) and you know of an avenue I have overlooked, PLEASE....contact me. I got a taste of normal, a taste of what you and most of society feels every day, and I want it back...desperately.

Tags: VNS Vagus Nerve Stimulator Remission Blue Cross Shield Insurance Cyberonics

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