Re: Insurance Dilemma- Advice needed!

[Guest guest]

Hi Amy,

I wish I had more advice this insurance stuff can be so frustrating. We are now

going through an appeal with Blue Cross for denying new AFOS for my son.

When talking to the insurance company aside from writing down when you called

and who you talked to also write down everything that you tell them and

everything they tell you. Stay on top of them. Certified mail will help also.

I am learning the hard way.

I did two phone appeals and they claimed they didn't have any record of it.

Actually one Blue Cross phone record said I did NOT want to appeal. I had my

doctor appeal he did it by fax and Blue Cross claimed he never did an appeal and

they couldn't locate any record.

So we went over 30 days thinking we had appealed. I *think* we have finally

worked this out.

If you keep at it you may finally get a hold of someone that knows what they are

doing.

[Guest guest]

Hi Amy -

A couple of ideas came to mind that may or may not help your

situtation. (I hope they do)

Before going national, it's always a good idea to start at the local

level with the Media. Construct a well written letter that is

succinct and factual. Then systematically contact local television

Investigative Reporters and get someone hooked on your cause.

Sometimes, a simple telephone call from a reporter will do wonders.

Also, contact your Doctors office and double check to make certain

that they coded everything correctly. Ask them to resubmit the

claim on your behalf. It can't hurt to do this and you may be

surprised by what happens. (Sometimes the left hand doesn't know

what the right hand is doing at insurance companies. You might get

lucky and have it approved and paid)

I would also suggest contacting your local MDA and see if they can

help you out with this.

Good luck and please keep us posted.

[Guest guest]

Amy,

Fight this. Appeal again. You have all the info/records stating BCBS

would cover the test. Now, since the denial occurred a 2nd time, it

seems BCBS just doesn't want to pay! That genetic test is neither

genetic experimental or investigational.

Suggestions: Call Athena again, speak to Executive Management.

Secondly, call BCBS and speak to the same. Or you can write to both,

and then you'd had more hard copy of your appeal.

" Point-of-service (POS) coverage is a healthcare option that allows

members to choose medical services that are needed and whether they

will go to a provider within the BCBS plan's network or seek medical

care outside of the network " . (from the BCBS website) You went out

of 'network' but as this paragraph states, members have a choice.

Were you in Athena's Patient Protection Plan by chance? At anyrate,

here's a toll free # Athena's toll free number: 1-800-394-4493 and

ask to speak to Reimbursement Services.

Consider a Hearing if you still get nowhere. You can represent

yourself, you can also have someone from Legal Aid, or even a 3rd

year law student help. And request the Hearing be in Dallas, due to

your CMT. It seems BCBS doesn't want to pay and it attempting to

scare you with a Hearing.

I agree with you 100% on the state of healthcare here!

Gretchen

>

[Guest guest]

Hi Amy,

I'm so sorry this happened.  I believe I can help you.  I will email you

privately.

[Guest guest]

Thanks to all of you who responded to my post...I feel even more determined to

fight this with all of that GREAT encouragement! It's only $600, but it's the

principle of the matter.

Thanks so very much!

Amy Hodge