Appeal denied

[cobbiemommy]

We just got the mail and our massive appeal to BCBS of KS has been denied. They are using CDC criteria against us, even with all of the supporting documentation.

 

I am just stunned...

[tpotter]

What was the diagnosis code?

[cobbiemommy]

I cannot find the paperwork at this moment, but I know it included tick borne infection and Lyme. The other doctor used vague coding such as neck pain, fatigue, anxiety, etc. They have not paid for his office visits yet, either.

 

The main focus of their appeal is that we did not follow IDSA guidelines, get an ELISA and then a Western Blot. Never mind that the Western blot, together with clinical findings is enough to make a diagnosis.

 

Sure am hoping that they don't try to get back all the money for antibiotics as well.

[LNN]

You may want to contact ILADS or http://www.lymefight.info/ the KC/MO lyme organization to see if they can help you with some patient advocacy. I suspect the local group may have already helped others in a similar situation and know local laws, best approaches toward fighting this.