melanie Posted December 9, 2009 Report Posted December 9, 2009 I thought i was on the right track now I feel like Im going backwards Im so tired of this .Does this ever end? Insurance company denied 1st appeal .Now what ? Melanie
brooke Posted December 10, 2009 Report Posted December 10, 2009 I thought i was on the right track now I feel like Im going backwards Im so tired of this .Does this ever end? Insurance company denied 1st appeal .Now what ? Melanie I am not sure what they denied? Will try to help once I know. Brooke
thereishope Posted December 10, 2009 Report Posted December 10, 2009 Blue Cross Blue Shield for another IVIG? Did you appeal it on your own or with a lawyer?
melanie Posted December 10, 2009 Author Report Posted December 10, 2009 I thought i was on the right track now I feel like Im going backwards Im so tired of this .Does this ever end? Insurance company denied 1st appeal .Now what ? Melanie I am not sure what they denied? Will try to help once I know. Brooke They denied the appeal for IV i think the neurologist who di dthe 1st IV has given up
melanie Posted December 10, 2009 Author Report Posted December 10, 2009 Blue Cross Blue Shield for another IVIG? Did you appeal it on your own or with a lawyer? We appealed it with some help from my union it doesnt matter its just not going to work.My whole family are lawyers they all would help the insurance clearly says not covered for pandas .Even though they did pay for the 1st iv. Melanie
brooke Posted December 10, 2009 Report Posted December 10, 2009 Blue Cross Blue Shield for another IVIG? Did you appeal it on your own or with a lawyer? We appealed it with some help from my union it doesnt matter its just not going to work.My whole family are lawyers they all would help the insurance clearly says not covered for pandas .Even though they did pay for the 1st iv. Melanie We have the same insurance. We did IVIG in July, and now they are saying that they will not cover! I wish I knew what to say. Is it outpatient or Inpatient? I am so sorry. I too have read their website. Thinking of you!
melanie Posted December 10, 2009 Author Report Posted December 10, 2009 Blue Cross Blue Shield for another IVIG? Did you appeal it on your own or with a lawyer? We appealed it with some help from my union it doesnt matter its just not going to work.My whole family are lawyers they all would help the insurance clearly says not covered for pandas .Even though they did pay for the 1st iv. Melanie We have the same insurance. We did IVIG in July, and now they are saying that they will not cover! I wish I knew what to say. Is it outpatient or Inpatient? I am so sorry. I too have read their website. Thinking of you! I think Dr Sultan wanted to do inpatient thats what he did the 1st time .I have no idea what dr T would do probably outpatient I will pay for it but cant seem to get anywhere .Have you used drK?
thereishope Posted December 10, 2009 Report Posted December 10, 2009 Do you know what you are going to do? Can you somehow find the funds yourself?
Worried_Dad Posted December 10, 2009 Report Posted December 10, 2009 Man, this sucks... and with BCBS, even when it's covered, it may not be covered. Dr. K uses a non-PANDAS diagnosis code (I think it corresponds to some general immune deficiency) so that insurance co's will cover it. We went through our HR Benefits folks and were told the procedure codes were all pre-approved for that diagnosis code. It's been 6 months since our summer rounds of IVIG (2) with Dr. K, and we still have not been reimbursed a penny. Had to pay up-front, of course. Can't ever get a straight answer as to why no Explanation of Benefits after all this time, just that it's in "special processing." We ended up taking out a loan against our 401(k) to cover the costs. (Melanie, if you or your husband have a 401(k) or IRA with a decent balance in it, I believe you can withdraw or borrow against the funds penalty-free for a "medical emergency," and the loan interest rates are extremely low.) Best of luck. PANDAS families should not have to cope with the extra stress of health insurance hassles. I HATE OUR HEALTHCARE SYSTEM!!!
melanie Posted December 10, 2009 Author Report Posted December 10, 2009 Man, this sucks... and with BCBS, even when it's covered, it may not be covered. Dr. K uses a non-PANDAS diagnosis code (I think it corresponds to some general immune deficiency) so that insurance co's will cover it. We went through our HR Benefits folks and were told the procedure codes were all pre-approved for that diagnosis code. It's been 6 months since our summer rounds of IVIG (2) with Dr. K, and we still have not been reimbursed a penny. Had to pay up-front, of course. Can't ever get a straight answer as to why no Explanation of Benefits after all this time, just that it's in "special processing." We ended up taking out a loan against our 401(k) to cover the costs. (Melanie, if you or your husband have a 401(k) or IRA with a decent balance in it, I believe you can withdraw or borrow against the funds penalty-free for a "medical emergency," and the loan interest rates are extremely low.) Best of luck. PANDAS families should not have to cope with the extra stress of health insurance hassles. I HATE OUR HEALTHCARE SYSTEM!!! Thats relly great advise I will ask him melanie
Recommended Posts
Create an account or sign in to comment
You need to be a member in order to leave a comment
Create an account
Sign up for a new account in our community. It's easy!
Register a new accountSign in
Already have an account? Sign in here.
Sign In Now