Guest guest Posted November 2, 2001 Report Share Posted November 2, 2001 > I think I remember reading some where that they approved 85 MGB's. I > am having hell getting them to cover anything now.Everything has to > be requested twice by my PCP. It's really getting to be a real pain. > I've had no problems except for the dumping from sugar. They would > only pay $250.00 of the 1400.00 for my one year blood work. They said > it was an unusal amount of blood work for a ckeck up. > If anyone is concidering a class action suit give me a call. I might > want to help out. Okay off my soap box and back to fighting fires. > Ann in Oklahoma MGB3/20/00 263/158 wanting 150 Ann - you can definitely talk to Ginny Ivanoff about the BCBS thing. She also has the impression that since they originally approved her stomach surgery, then abruptly un-approved it after finding out she was a MGB patient, that she is being targetted. If anyone out there is having similar problems - like usual insurance claims that had formerly been approved by BCBS are now either being denied or heavily scrutinized, you should post about it. And a class action suit would not be out of the question. Just my two cents! Eileen Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 30, 2003 Report Share Posted June 30, 2003 HI Trish, I had BCBS out of Illinois and had no difficulty at all getting approval. I got al my medical information and sent it online to Dr. R. Although I had Dr. O'Brien perform my surgery, because of the problems Dr. Rutledge was having at the time, all my documentation was done by Dr. R. I also wrote a letter to BC explaining what my life was like on a daily basis as an obese woman and all the struggles I was having. I don't know if everyone had this experience with them but that was the easiest part of my journey for me. I wish you the very best in your pursuit for this surgery, it's really worth fighting for. It's the best thing I have ever done for myself. Pat Petrin August 2,2001 316/187 BCBS > Hello, > > I am in my stage one appeals process to BCBS of NC. Unless a miracle happens I am NOT expecting them to pay. So, I am getting my " ammo " ready for level two. Anyone who has had BCBS of NC or any other state pay please send me an email (private if you feel more comfortable) about how you got them to pay for the MGB. I had my surgery on 2/12/03 and started requesting for reimbursement on 2/19/03 so I haven't " dragged my feet " on the process. > Any information will be greatly appreciated. > > Trish Wagner > Dr. R 2/12/03 > 279/221 > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 10, 2006 Report Share Posted November 10, 2006 You are right for implants in general. I was talking about BILATERAL IMPLANTS. Adding them as medically necessary was LTHF's work. Lydia > > I think we may need to give credit where credit is due here. My > information tells me that clearing the way for implants thru BCBS has > been mostly the work of HLAA (formerly SHHH) and the manufacturers. > > Alice > http://www..com > > > > > All of Anthem (PDF): > > > http://www.anthem.com/medicalpolicies/noapplication/f4/s10/t2/pw_034076. > pdf > > > > BCBS of GA (another one, text-based): > > > https://provider.bcbsga.com/provider/medpolicy/policies/SURG/cochlear_im > plants.html > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 10, 2006 Report Share Posted November 10, 2006 Excellent! If this is true, they have done a great service to many and the funding was provided in part (I'm sure there are other donors) by all the cochlear implant companies. I'm feel confident that they will continue just as HLAA and AG Bell will continue to advocate for CI users. The manufacturers make huge donations to these great organizations. It's their responsibility and right to make choices that they feel will bring the greatest results. Regardless of those choices, we the consumers have a certain responsibility to make our own donations, personal checks, give our tax refunds, adjust our wills etc., advocate and work towards these issues as well. We too have the right to make the choice of how we wish to do this. Alice http://www..com > > > > I think we may need to give credit where credit is due here. My > > information tells me that clearing the way for implants thru BCBS has > > been mostly the work of HLAA (formerly SHHH) and the manufacturers. > > > > Alice > > http://www..com > > > > > > > > > All of Anthem (PDF): > > > > > http://www.anthem.com/medicalpolicies/noapplication/f4/s10/t2/pw_03407 6. > > pdf > > > > > > BCBS of GA (another one, text-based): > > > > > https://provider.bcbsga.com/provider/medpolicy/policies/SURG/cochlear_ im > > plants.html > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 10, 2006 Report Share Posted November 10, 2006 It is true. It does not yet affect every Blue Cross/Blue Shield across the US, but this particular change affects a great many policyholders: all individuals in the Anthem and Empire families, as well as Blue Cross in California, Georgia, Wisconsin and Virginia. Here is the news item from LTHF's site: http://advocacy.letthemhear.org/news-7.25.2006.php Other BCBSes have followed or will be following. Ours in Massachusetts has not yet revised its policy to include bilaterals, but I have heard that it plans to. And yes, the implant companies and many private individuals helped make this possible. Lydia > > Excellent! If this is true, they have done a great service to many > and the funding was provided in part (I'm sure there are other > donors) by all the cochlear implant companies. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 10, 2006 Report Share Posted November 10, 2006 You know Alice your post is interesting. My husband works for the Department of Defense and they have what they call the Combined Federal Campaign (like United Way) and you can choose who you want the money to go to. He tried to give it to HLAA as they were listed with a code number, however, the code number wouldn't work and couldn't give it. He did try to notify someone at HLAA but it was not in time for him to have his donation go to them. Has anyone else had this problem? Connie Alice <alice@...> wrote: Excellent! If this is true, they have done a great service to many and the funding was provided in part (I'm sure there are other donors) by all the cochlear implant companies. I'm feel confident that they will continue just as HLAA and AG Bell will continue to advocate for CI users. The manufacturers make huge donations to these great organizations. It's their responsibility and right to make choices that they feel will bring the greatest results. Regardless of those choices, we the consumers have a certain responsibility to make our own donations, personal checks, give our tax refunds, adjust our wills etc., advocate and work towards these issues as well. We too have the right to make the choice of how we wish to do this. Alice http://www..com > > > > I think we may need to give credit where credit is due here. My > > information tells me that clearing the way for implants thru BCBS has > > been mostly the work of HLAA (formerly SHHH) and the manufacturers. > > > > Alice > > http://www..com > > > > > > > > > All of Anthem (PDF): > > > > > http://www.anthem.com/medicalpolicies/noapplication/f4/s10/t2/pw_03407 6. > > pdf > > > > > > BCBS of GA (another one, text-based): > > > > > https://provider.bcbsga.com/provider/medpolicy/policies/SURG/cochlear_ im > > plants.html > > > > > > " The Miracle at Ohio State " aka Nucleus Freedom Implanted 10/04/2005 Activated 11/1/2005 Surgery: Ohio State University Surgeon: Dr. Bradley Welling http://internalmedicine.osu.edu/article.cfm?ID=2021 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 10, 2006 Report Share Posted November 10, 2006 > ... > And yes, the implant companies and many private individuals helped > make this possible. AND, I forgot to add, a number of surgeons and audiologists also helped to bring this about by meeting with the insurance companies to discuss the evolving standard of care. Thanks go to all!! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 25, 2008 Report Share Posted July 25, 2008 This is also happening in CA. Fiona Ma sponsored a bill in the Assembly to force insurers to honor assignment, things were looking good. The last few days before the vote BCBS had a half dozen lobbyist's scurrying around the capitol and not surprisingly the bill died because quite a few legislators failed to "show up" for the vote.I hope you guys in OR can get something done about this! Go Vern!Anyone bringing their portable table to the Brewfest this weekend? See you there!S R. Swanson DC CCEPParkside Chiropractic2394 31st AvenueSan Francisco, CA 94116(v)415.566.7134(f)415.566.8702www.ParksideChiro.com On Jul 25, 2008, at 6:59 AM, D Beebe, D.C. wrote:Hi all I am looking into the actions of Blue Cross Blue Shield in which they are not sending checks to us providers on the " BLUE CARD" members even though our HCFA forms are assigning benefits. They are only doing this to DC's and it is a brazen attempt to get the DC's in the area to " join" their panel. In the contract that they sent to us all back in 4th qtr last year there were issues that were against ORS in the contract... ie, they were insisting that they could retro actively decide medical necessity for a 6 month period. Currently we are looking at the legalities involved in this action by BCBS and it appears that a breach of contract is warranted for action. It may be the basis for a class action suit and I will keep you all inforned regarding the matter. Please contact me offline if this has presented a problem for your office. I have several patients who have gotten checks thinking it was " free money " and spent the checks and now have biils that they have had to dip into savings to settle. Hoping to rein these arrogant people in. Dr B Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 25, 2008 Report Share Posted July 25, 2008 any chance I could get a copy of this proposed bill/law? Or at the very least get me the bill number? House? Senate? Thanks, Vern Re: BCBS This is also happening in CA. Fiona Ma sponsored a bill in the Assembly to force insurers to honor assignment, things were looking good. The last few days before the vote BCBS had a half dozen lobbyist's scurrying around the capitol and not surprisingly the bill died because quite a few legislators failed to "show up" for the vote. I hope you guys in OR can get something done about this! Go Vern! Anyone bringing their portable table to the Brewfest this weekend? See you there! S R. Swanson DC CCEP Parkside Chiropractic 2394 31st Avenue San Francisco, CA 94116 (v)415.566.7134 (f)415.566.8702 www.ParksideChiro.com On Jul 25, 2008, at 6:59 AM, D Beebe, D.C. wrote: Hi all I am looking into the actions of Blue Cross Blue Shield in which they are not sending checks to us providers on the " BLUE CARD" members even though our HCFA forms are assigning benefits. They are only doing this to DC's and it is a brazen attempt to get the DC's in the area to " join" their panel. In the contract that they sent to us all back in 4th qtr last year there were issues that were against ORS in the contract... ie, they were insisting that they could retro actively decide medical necessity for a 6 month period. Currently we are looking at the legalities involved in this action by BCBS and it appears that a breach of contract is warranted for action. It may be the basis for a class action suit and I will keep you all inforned regarding the matter. Please contact me offline if this has presented a problem for your office. I have several patients who have gotten checks thinking it was " free money " and spent the checks and now have biils that they have had to dip into savings to settle. Hoping to rein these arrogant people in. Dr B Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 25, 2008 Report Share Posted July 25, 2008 We have had a problem with that in our office. We have even gotten provider relations on the phone in office to talk to the patient so the patient could hear from them first hand that the checks have to go to them and they are to bring the checks into us, or pay us that amount. When they call thier number for patient services, they are told a completely different story and that they can have the checks sent to us or keep them.... The fact that they are being told something different when they talk to bcbs vs when we talk to them is the most upsetting part to me. So we have had a few angry patients over this issue. For the most part our receptionist is good at catching the ones who have this and explaining it to them. We joined the panel only because as of this year if you are out of network bcbs take an additional 25 dollar out of network fee from the amount the patient will be reembursed. Just a little tough to eat that amount for some of our patients. Respectfully, Dr. Franchesca HarperFunctional Pain Solutions6956 SW Hampton StTigard, OR 97223p. 503-443-6100f. 503-443-1280 From: daniel.beebe@...Date: Fri, 25 Jul 2008 06:59:53 -0700Subject: BCBS Hi all I am looking into the actions of Blue Cross Blue Shield in which they are not sending checks to us providers on the " BLUE CARD" members even though our HCFA forms are assigning benefits. They are only doing this to DC's and it is a brazen attempt to get the DC's in the area to " join" their panel. In the contract that they sent to us all back in 4th qtr last year there were issues that were against ORS in the contract... ie, they were insisting that they could retro actively decide medical necessity for a 6 month period. Currently we are looking at the legalities involved in this action by BCBS and it appears that a breach of contract is warranted for action. It may be the basis for a class action suit and I will keep you all inforned regarding the matter. Please contact me offline if this has presented a problem for your office. I have several patients who have gotten checks thinking it was " free money " and spent the checks and now have biils that they have had to dip into savings to settle. Hoping to rein these arrogant people in. Dr B Time for vacation? WIN what you need. Enter Now! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 25, 2008 Report Share Posted July 25, 2008 Drs. Beebe, Harper and colleagues, I spoke at length to a very nice gal in the “Insurance Consumer Advocacy Unit” about this issue. What I and the profession need you and other colleagues with the same or similar occurrence(s) from BCBS is to absolutely have your angry patients file a formal complaint with the Consumer Advocacy Unit they or you can fill out most of the form posing the question “I don’t understand when I sign a rights to assignment at the doctor’s office why you (BCBS) don’t send the check for payment of the doctors services to the doctor rather than sending it to me?” The gal in the unit needs a complain(s) from consumers not doctors before they can act and this will allow them to investigate and gain an “official” statement/rational from BCBS as per why they send checks to the patient rather than the doctor. Once we memorialize BCBS’s (bogus) reasoning for such a practice we can then better act……call 503-947-7277 follow the prompts to get to an investigator who can send a complaint form or walk you through their web page to print a pdf version from your computer then have the patient fill it out and send it in…..Vern Saboe From: [mailto: ] On Behalf Of Franchesca Harper Sent: Friday, July 25, 2008 9:25 AM oregondc Subject: RE: BCBS We have had a problem with that in our office. We have even gotten provider relations on the phone in office to talk to the patient so the patient could hear from them first hand that the checks have to go to them and they are to bring the checks into us, or pay us that amount. When they call thier number for patient services, they are told a completely different story and that they can have the checks sent to us or keep them.... The fact that they are being told something different when they talk to bcbs vs when we talk to them is the most upsetting part to me. So we have had a few angry patients over this issue. For the most part our receptionist is good at catching the ones who have this and explaining it to them. We joined the panel only because as of this year if you are out of network bcbs take an additional 25 dollar out of network fee from the amount the patient will be reembursed. Just a little tough to eat that amount for some of our patients. Respectfully, Dr. Franchesca Harper Functional Pain Solutions 6956 SW Hampton St Tigard, OR 97223 p. 503-443-6100 f. 503-443-1280 From: daniel.beebeverizon (DOT) net Date: Fri, 25 Jul 2008 06:59:53 -0700 Subject: BCBS Hi all I am looking into the actions of Blue Cross Blue Shield in which they are not sending checks to us providers on the " BLUE CARD " members even though our HCFA forms are assigning benefits. They are only doing this to DC's and it is a brazen attempt to get the DC's in the area to " join " their panel. In the contract that they sent to us all back in 4th qtr last year there were issues that were against ORS in the contract... ie, they were insisting that they could retro actively decide medical necessity for a 6 month period. Currently we are looking at the legalities involved in this action by BCBS and it appears that a breach of contract is warranted for action. It may be the basis for a class action suit and I will keep you all inforned regarding the matter. Please contact me offline if this has presented a problem for your office. I have several patients who have gotten checks thinking it was " free money " and spent the checks and now have biils that they have had to dip into savings to settle. Hoping to rein these arrogant people in. Dr B Time for vacation? WIN what you need. Enter Now! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 28, 2010 Report Share Posted January 28, 2010 healthwell foundation! i received a $4000.00 grant for my Humira co pay last year after my husband laid off. i was told about them by the makers of Enbrel. McGillvary <alexsmom45326@...> Quote Link to comment Share on other sites More sharing options...
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