Perry and Dan: A Private Insurance Appeal<\/h2>\n\n\n\n
When she saw the difference that focused ultrasound treatment could make for patients with essential tremor (ET), Perry Payne Millner advocated for her father, Dan Payne, to ensure that his private insurance would pay for the life-changing procedure.<\/p>\n\n\n
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In 2013, Perry was living in Charlottesville when she learned of a clinical trial for ET. Her father had suffered with tremors since 1993, when he was 55 years old. At that time, he stopped playing golf because he couldn\u2019t control the club like he used to. The ET progressed every year. Unfortunately for Dan, the trial was closed, and the procedure would cost $30,000 out-of-pocket. Her father decided to wait until Medicare approved the treatment; they had no idea it would take six years.<\/p>\n\n\n\n
\u201cThe Medicare coverage should have been approved one year earlier than it was,\u201d Perry said. \u201cPaperwork glitches and Medicare deadlines caused delays, but early in January 2019, the approvals came through and we jumped on it.\u201d<\/p>\n\n\n\n
Although Dan had enrolled in Medicare, he also had private health insurance. To secure coverage, the family first called Medicare, which they found would ultimately cover all but $7,500.<\/p>\n\n\n\n
The private insurance provider, affiliated with the regional hospital system, said it would cover up to $15,000, but getting that coverage was cumbersome. \u201cWe had to get letters from two of dad\u2019s doctors, with supporting forms and recommendations, to be reviewed by a panel. We completed the paperwork and submitted it to the insurance company in January or February, where the package sat and sat,\u201d Perry recalls. After countless phone calls and many, many weeks she drove to the office and found a helpful person to take up the family\u2019s cause. Upon review, and after almost four months, the contact at the insurance company told her that her father\u2019s file was incomplete and that his doctors would have to fill out another form. The insurance company had not asked the doctors (Dan\u2019s internist and cardiologist) to submit the needed forms.<\/p>\n\n\n\n
\u201cApparently, the doctors have to fill out this form any time they recommend a treatment,\u201d said Perry. Losing patience, she made it her personal mission to see the process through. \u201cI went to both doctors\u2019 offices. Both told me to come back later. I declined. I asked each of them to send down a nurse or someone to sign these forms\u2014I told them \u2018I\u2019ll wait.\u2019 I waited an hour in one office and 90 minutes in the other. I did not leave until the forms were signed.\u201d<\/p>\n\n\n\n
Forms in hand, she proceeded immediately to the insurance office, where she was told a panel would meet to approve Dan\u2019s treatment. The \u201cpanel,\u201d she discovered, was a sole nurse practitioner on staff. Perry asked the nurse practitioner to meet her in the lobby, on the spot. \u201cAgain, I said, \u2018I\u2019ll wait,\u2019\u201d said Perry. \u201cI might have been pushy, but we\u2019d been waiting six years already. My dad was not getting any younger!\u201d<\/p>\n\n\n\n
The panel approved the treatment and gave Dan one month from that day to see Dr. Elias at the University of Virginia (UVA) in Charlottesville. \u201cI called UVA for an appointment and told her that my dad had one month to commence treatment,\u201d said Perry, who was astonished to learn that the waiting list was four years long! \u201cWhen I told her that we had been working on this since 2013 and was able to provide proof of our conversations, Dad was moved to the top of the waiting list.\u201d Even more amazing was that another patient with treatment scheduled for the next month had to cancel; Dan was more than happy to take his spot.<\/p>\n\n\n\n
Because the treatment planning appointments took about a month to complete, Perry was able to secure an extension from the insurance company for her dad\u2019s treatment date. Dan was finally treated in July 2019, only four months after his insurance approvals came through.<\/p>\n\n\n\n
\u201cMy takeaway is that older patients need someone to advocate for them,\u201d says Perry. \u201cThey need help with the paperwork, the technology, the insurance. My dad\u2019s generation has such respect and reverence for physicians; they don\u2019t want to rock the boat or seem pushy. But somebody has to get past the red tape and through the bureaucracy.\u201d Dan\u2019s story ended happily. \u201cIn the end, I don\u2019t think he paid a penny out of pocket,\u201d Perry reports. He\u2019s 82, and only retired in September of this year.<\/p>\n\n\n\n
\u201cAt lunch on the way to UVA for his treatment, I watched my dad try to cut into an eclair\u2014his tremor sent the plate flying across the table,\u201d said Perry. \u201cHe wouldn\u2019t eat in the dining room at the hospital because he thought the powers that be would notice his disability and make him quit working.\u201d He is happy to report that his quality of life is much improved. Happily, \u201cHe can go to a cocktail party and hold both drink AND plate,\u201d his daughter chuckles. He was excited to retire this fall so he can enjoy life and family more. \u201cIt\u2019s a happy ending for sure,\u201d she reports.<\/p>\n\n\n\n
Editor\u2019s note: Dan Payne fully retired in September 2020 and is doing well one year after the treatment, which did reveal some gait and balance problems. He is working through physical therapy and exercise to regain the unilateral loss in balance and strength that he experienced. Overall, his quality of life is much improved. It is Dan\u2019s understanding that his private insurance ultimately covered all or nearly all the expenses. He didn\u2019t pay a penny out of pocket.<\/em><\/p>\n","protected":false},"template":"","meta":{"_acf_changed":false,"_searchwp_excluded":"","_editorskit_title_hidden":false,"_editorskit_reading_time":0,"_editorskit_is_block_options_detached":false,"_editorskit_block_options_position":"{}","episode_type":"","audio_file":"","podmotor_file_id":"","podmotor_episode_id":"","cover_image":"","cover_image_id":"","duration":"","filesize":"","filesize_raw":"","date_recorded":"","explicit":"","block":"","itunes_episode_number":"","itunes_title":"","itunes_season_number":"","itunes_episode_type":"","_vp_format_video_url":"","_vp_image_focal_point":[],"footnotes":""},"sw_profile_cat":[303],"class_list":["post-30315","sw_profile","type-sw_profile","status-publish","hentry"],"acf":[],"yoast_head":"\nDan Payne - Focused Ultrasound Foundation<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.fusfoundation.org\/profiles\/dan-payne\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Dan Payne\" \/>\n<meta property=\"og:description\" content=\"Perry and Dan: A Private Insurance Appeal When she saw the difference that focused ultrasound treatment could make for patients with essential tremor (ET), Perry Payne Millner advocated for her father, Dan Payne, to ensure that his private insurance would pay for the life-changing procedure. 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