Insurance Dilemma- Advice needed!

[Guest guest]

I have CMT and was suspicious that my father might have it even though his nerve

conduction test were normal. Last year, we had his doctor order genetic testing

via Athena.

Prior to actually having this done, I contacted Athena, who told me that my

dad's

insurance, BCBS were contracted with them since he was under a POS plan. They

even gave

me the contract # for reference and I documented who I spoke with, etc.

My mother also called BCBS and was told that the procedure codes that she gave

them

(from Athena) were covered by BCBS. We documented who we spoke with, etc.

BCBS denied the claim. When I called to speak to someone at BCBS, he told me

that we

were given misinformation, but that there was specific documentation that my mom

had

called, etc. He encouraged me to appeal the denial, which I did. That was March.

Last week, my dad received a letter basically denying the appeal stating that

genetic

testing was " experimental/investigational " and that they agreed with the BCBS

decision.

How is this? If we are using genetic testing as a way to confirm a diagnosis,

how is that

investigational?

Even putting that issue aside, Athena AND BCBS should be giving out correct

information

to their clients. No where else in the business world would this type of

situation fly. Their

reps represent their company and should stand behind their word and demonstrate

some

integrity.

They mentioned that we could appeal the decision again and there would be some

sort of

administrative hearing held in Austin. They said that a staff atty would be

representing

ERS (Employees Retirement System of Texas-my dad is a teacher) and another atty

would

represent BCBS. They said that we could have an atty.

We are in Dallas and don't plan to go to Austin and certainly don't plan on

wasting any of

our money on an atty.

I do plan to appeal the decision and also plan to write to some of the national

news in

regards to this issue and many others I have experienced since being diagnosed

in 2004.

Insurance is such a complete joke in the US.

Any advice after reading my long novel would be great!

Amy