Insurance Denying claim

[Guest guest]

Has anyone had experience in dealing with Blue Cross/Blue Shield of ILLINOIS?

(We live in

CA, but hubby's employer is based out of Chicago).

We had EEG's done on both our 3yo boys with autism at the recommendation of

their

neurologist. One because he " spaces out " frequently and the other because he

walks to

the left (rarely straight) and because I had a video of him " spacing out " as

well.

Each test was $1470 and BCBS denied BOTH. We got a letter on one stating the

claim was

denied but the letter didn't state why. So we called. We were told the EEG

company that

did the test billed it correctly, but the end result diagnosis stating

" psychological " . We

have psych benefits but of course these have to be pre-approved. I told the

BCBS woman

that was interesting because when I called the neuro for the results, we were

told

" everything was fine " . So does " psychological " mean we were making it up when

this was

HIS recommendation or does it mean they have " psychological " issues? She

couldn't tell

me.

She said the would look into it further and let us know if they would approve

it. We got

another denial rejection letter in the mail yesterday.

I have spent the better part of the last 10 days trying to get through to

someone in the

billing dept of the neuro's office and keep getting the run around.

This happened once before when the neuro recommended some fabulous new blood

test

that tests 3500 genetic abnormalities with a microchip. The neuro got a

pre-approval for

the test, we took them to a special lab that draws the blood a particular way

then sends it

to GA overnight in a special container. When it got to the company in GA, they

called me

and asked how we'd like to pay the $1900 for the test. HUH?! This was all

pre-approved

by the insurance. Uh, no, we don't BILL insurance. OK, well toss the sample

then because

I don't have $1900 for this test.

The neuro's office then called me PO'd because I didn't follow through. When I

told her I

didn't have the $1900, she backed off and said she'd confer with the dr. about

what to do.

Never heard anything about that.

If it weren't for the fact that I LIKE this neuro (there's only 2 pede neuros in

our area and

we saw the other one first - he spent TEN minutes with us and our twins, barely

remembering their names and sent us on our way with PDDNOS, then I'd tell him to

take a

hike as well. Sorta stuck here.

Anyway - I digressed on my point: I've heard that when BC or BS starts denying

tests or

paying for claims, then they've figured out the kids have Autism and eventually

drop them.

Obviously, I don't want to tell them that we had this test because they have

autism and the

neuro was looking for any underlying possibilities because if they don't know by

now, I

don't want them to know.

Also, one of the boys will be having and MRI on his brain and neck tomorrow.

I've called

the insurance and was told that IF it is ordered by the dr., then it's paid for.

Uh-huh.

Somehow I've heard this one before.

So......has anyone else had this problem, fought it, appealed it and won? How'd

you do it?

Thanks!

Le