Confused regarding Insurance Request

[Guest guest]

Hi All:

I have been following the conversation regarding

billing codes. Unfortunately, I just had a

conversation with Blue Shield of California and I am

so confused. I thought I would see if any of you can

clue me in on what this really means.

We have Blue Shield HMO of California. We went through

our pediatrician, got a referral to a neurosurgeon and

obtained pre approval from our provider group (after a

successful appeal regarding medical necessity). We

have since obtained the DOC Band and CT submitted a

bill to Blue Shield. It has now been 2 months since

we started treatment and Blue Shield has indicated

that it must go through their medical management

department to obtain a pre authorization # from Blue

Shield (in addition to the pre auth from the provider

group). The rep told me that CT should've obtained a

pre authorization number from Blue Shield before

treatment.

So now Blue Shield has said that CT can submit medical

records to support medical necessity along with a copy

of the pre auth from the provider group. They will

review this information and hopefully respond within 3

weeks. I am hoping that some of you have experience

with this process and can tell me whether this is a

formality or if we are going to get left out to dry.

I also want to know what we should send to Blue

Shield. Based on prior e-mails, I am thinking that we

need to send the doctor's report, the pre auth from

the provider group as well as a detailed explanation

of the Band and its effectiveness from CT (or is this

too much?)

Any help would be appreciated.

Thanks,

Tami (mom to Annika)

__________________________________________________

[Guest guest]

Tami:

No wonder why you are confused! It sounds like they need this, then

they need that and so on. I'm sorry, I really can't input any

helpful advice or information to help.

I'm wondering how Annika is doing in her band??? Hope all is well.

Good luck with ins..

Debbie Abby's mom DOCGrad

MI

> Hi All:

>

> I have been following the conversation regarding

> billing codes. Unfortunately, I just had a

> conversation with Blue Shield of California and I am

> so confused. I thought I would see if any of you can

> clue me in on what this really means.

>

> We have Blue Shield HMO of California. We went through

> our pediatrician, got a referral to a neurosurgeon and

> obtained pre approval from our provider group (after a

> successful appeal regarding medical necessity). We

> have since obtained the DOC Band and CT submitted a

> bill to Blue Shield. It has now been 2 months since

> we started treatment and Blue Shield has indicated

> that it must go through their medical management

> department to obtain a pre authorization # from Blue

> Shield (in addition to the pre auth from the provider

> group). The rep told me that CT should've obtained a

> pre authorization number from Blue Shield before

> treatment.

>

> So now Blue Shield has said that CT can submit medical

> records to support medical necessity along with a copy

> of the pre auth from the provider group. They will

> review this information and hopefully respond within 3

> weeks. I am hoping that some of you have experience

> with this process and can tell me whether this is a

> formality or if we are going to get left out to dry.

> I also want to know what we should send to Blue

> Shield. Based on prior e-mails, I am thinking that we

> need to send the doctor's report, the pre auth from

> the provider group as well as a detailed explanation

> of the Band and its effectiveness from CT (or is this

> too much?)

>

> Any help would be appreciated.

>

> Thanks,

> Tami (mom to Annika)

>

> __________________________________________________

>

[Guest guest]

Hi,

I have BCBS of Oregon, PPO and they are paying 100%

after a successful appeal based on medical necessity

also. I'm confused when you refer to the " provider

group. " I'm also confused that Blue Shield is

requesting records to support medical necessity.

Didn't you already send all this info with your

appeal? If you are using CT in Burbank, they have a

copy of a letter to Bitting from BS of

California stating that they cover the DOC Band. I

used this in my appeal. All the information you have

is absolutely not too much info.

, 's mom

Southern California

<tsesq@...> wrote:

> Hi All:

>

> I have been following the conversation regarding

> billing codes. Unfortunately, I just had a

> conversation with Blue Shield of California and I am

> so confused. I thought I would see if any of you can

> clue me in on what this really means.

>

> We have Blue Shield HMO of California. We went

> through

> our pediatrician, got a referral to a neurosurgeon

> and

> obtained pre approval from our provider group (after

> a

> successful appeal regarding medical necessity). We

> have since obtained the DOC Band and CT submitted a

> bill to Blue Shield. It has now been 2 months since

> we started treatment and Blue Shield has indicated

> that it must go through their medical management

> department to obtain a pre authorization # from Blue

> Shield (in addition to the pre auth from the

> provider

> group). The rep told me that CT should've obtained a

> pre authorization number from Blue Shield before

> treatment.

>

> So now Blue Shield has said that CT can submit

> medical

> records to support medical necessity along with a

> copy

> of the pre auth from the provider group. They will

> review this information and hopefully respond within

> 3

> weeks. I am hoping that some of you have experience

> with this process and can tell me whether this is a

> formality or if we are going to get left out to dry.

>

> I also want to know what we should send to Blue

> Shield. Based on prior e-mails, I am thinking that

> we

> need to send the doctor's report, the pre auth from

> the provider group as well as a detailed explanation

> of the Band and its effectiveness from CT (or is

> this

> too much?)

>

> Any help would be appreciated.

>

> Thanks,

> Tami (mom to Annika)

>

> __________________________________________________

>

[Guest guest]

Tami,

I am so glad that replied to you, because I had no idea

what I was going to say about this. It really seems like half the

time with these insurance companies that they are talking out both

sides of their mouths! Good luck with this and let us know how it

goes!

Niki

Kaylie & Danny (STAR grads)

Phila., PA

> Hi All:

>

> I have been following the conversation regarding

> billing codes. Unfortunately, I just had a

> conversation with Blue Shield of California and I am

> so confused. I thought I would see if any of you can

> clue me in on what this really means.

>

> We have Blue Shield HMO of California. We went through

> our pediatrician, got a referral to a neurosurgeon and

> obtained pre approval from our provider group (after a

> successful appeal regarding medical necessity). We

> have since obtained the DOC Band and CT submitted a

> bill to Blue Shield. It has now been 2 months since

> we started treatment and Blue Shield has indicated

> that it must go through their medical management

> department to obtain a pre authorization # from Blue

> Shield (in addition to the pre auth from the provider

> group). The rep told me that CT should've obtained a

> pre authorization number from Blue Shield before

> treatment.

>

> So now Blue Shield has said that CT can submit medical

> records to support medical necessity along with a copy

> of the pre auth from the provider group. They will

> review this information and hopefully respond within 3

> weeks. I am hoping that some of you have experience

> with this process and can tell me whether this is a

> formality or if we are going to get left out to dry.

> I also want to know what we should send to Blue

> Shield. Based on prior e-mails, I am thinking that we

> need to send the doctor's report, the pre auth from

> the provider group as well as a detailed explanation

> of the Band and its effectiveness from CT (or is this

> too much?)

>

> Any help would be appreciated.

>

> Thanks,

> Tami (mom to Annika)

>

> __________________________________________________

>