Guest guest Posted September 19, 2000 Report Share Posted September 19, 2000 Hi Everyone!! I am having trouble getting BCBS to approve the surgery for me! I don't have the state employees policy, we have an HMO. Has anyone recently dealt with BCBS and been approved? They keep telling me they need more information from Dr. R's clinic visit. Barbara from Dr. R's office sent them a copy of the clinic visit paperwork and they are still not satisfied! They want to talk directly to him!! I e-mailed Dr. R last week and he told me he had done all he was willing to do with BCBS on my behalf. Although I am disappointed I understand where he is coming from. Has anyone got any suggestions? I wrote and faxed an appeal letter today- for all the good that will do. I am just about to give up hope!! I have done all I know to do!! So if anyone out there has any ideas please contact me! Big Red is in the same boat with me and she has helped tremendously!! I had a ball at Cattlemans last night- even if we were an hour late!! Everyone was so nice!! Good luck to all who are having surgery this week!!!! Dana Tart Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 20, 2000 Report Share Posted September 20, 2000 In a message dated 9/19/2000 11:05:34 PM Eastern Daylight Time, tartboys@... writes: << o if anyone out there has any ideas please contact me! Big Red is in the same boat with me and she has helped tremendously!! >> Hi Dana, I have no pointers for you, I just wanted to tell you how sorry I am for the hard time your ins. company is giving you. I know how you feel, but keep fighting, it sounds like they are at least thinking about it. Cathy Morrow in Lenoir, NC BMI 42 A journey of a thousand miles begins with a single step Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 20, 2000 Report Share Posted September 20, 2000 Hi. I also have Blue Cross, but it is a PPO type. I was denied twice before I was finally given approval, and even then, it took a phone call from a lawyer to the Doctor who does the approval to get mine approved the third appeal. They are very difficult, but your problem is most likely that you have not yet gotten the right person on the phone. By that, I mean that some people are MUCH more helpful in telling you exactly what they need in in order to get an approval. I am wondering if you could get your PCP to go to bat for you with Blue Cross rather than Dr. R.? Since your PCP is doing the bulk of your physical, he or she should be able to call Blue Cross for you. Usually, it is just a matter of giving the insurance company what they want. It is unreasonable for them to ask a physician to call them, anyway. Many physicians refuse to call because they have sent all of your medical information, and that is all the insurance company needs in order to do an approval. You also might want to try faxing your insurance company and explaining your situation. Tell them that your PCP did your physical and Dr. Rutledge did your sugical consult based on the RECOMMENDATION of your PCP. Explain to them that you have provided all of the required paperwork, such as a copy of the clinical notes(my company wanted clinical notes of my physical even though they would not tell me that)as well as the paperwork from your surgical consult. At least with email, you will have a clear, written response from them explaining their position. They are just trying to frustrate you enough to run you off. YOU PAY THEM, and if this is a covered benifit, they HAVE to pay if you meet the the requirements for surgery. Please don't give up! Stormy in Alabama MGB 8/11/00 > Hi Everyone!! > > I am having trouble getting BCBS to approve the surgery for me! I > don't have the state employees policy, we have an HMO. > > Has anyone recently dealt with BCBS and been approved? They keep > telling me they need more information from Dr. R's clinic visit. > Barbara from Dr. R's office sent them a copy of the clinic visit > paperwork and they are still not satisfied! They want to talk > directly to him!! > > I e-mailed Dr. R last week and he told me he had done all he was > willing to do with BCBS on my behalf. Although I am disappointed I > understand where he is coming from. > > Has anyone got any suggestions? I wrote and faxed an appeal letter > today- for all the good that will do. I am just about to give up > hope!! I have done all I know to do!! > > So if anyone out there has any ideas please contact me! Big Red is > in the same boat with me and she has helped tremendously!! > > I had a ball at Cattlemans last night- even if we were an hour > late!! Everyone was so nice!! Good luck to all who are having > surgery this week!!!! > > Dana Tart Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.