medical insurance reimbursement

[Guest guest]

Hi All,

Since we are on the topic of diagnostic codes today, I am wondering if

anyone has had success in getting reimbursement from Blue Shield for

phone consults (not covered under my insurance plan & I think not

generally covered under insurance plans). It is very difficult for me

to get my son out of the house and to his doctor who is a 1 1/2 hr

drive from our house, and yet usually we need to consult with him on a

weekly basis on some issue, whether it's pain management, new symptoms,

medication side effects, new tests to run, etc. And, even if I do get

him to the doctor's, the meager reimbursement I get barely pays the gas,

bridge toll, etc. so it's about a wash financially (doctor is out of

network of course, what BS contracted doctor would spend an hour or more

with a single patient?)

Over 1 year ago I filed an appeal on this and they voluntarily

reimbursed on some phone consults, ironically they reimbursed at a

higher rate than office visits, but then they stopped. I filed another

appeal this fall which they denied. I just filed for an independent

medical review by the state just cause I want to take this as far as I

am able to take it, for one thing it is ridiculous in my view, in this

age of global warming, that if the doctors are comfortable " seeing " the

patient over the phone, how is that any different than an in person

office visit, our doctor charges $350 per hour for his time, regardless

of the method.

And now that we are in Sedona AZ, we are a very long 2-day drive from

the primary care doctor and a 5-6 hour drive from our new doctor in

Benson, AZ, making the in person office visits even more difficult.

Interested in hearing your experiences...

Thanks, Sue V.