Insurance denied for the 3rd time

[saidie10]

So sorry to hear what you went through jay jay and what you are going through tpotter. We will find out this week if our son's IVIG will be covered. I am so nervous. I saw you posted about United's parent company, Golden Rule and I think it is so crazy that some insurance companies are covering it specifically for PANDAS while some if you even mention it you will be denied! How is it that some do and some don't? Shouldn't there be some type of universal thing going on here? How can one cover it plain as day if needed for PANDAS and another say "oh that is experimental?" None of this makes any sense to me. The thing for us is that my youngest son is on Golden Rule with my DH and I and my older son who is scheduled for IVIG in a couple of weeks is still on BCBS because we did not try and move him after the Neurologist diagnosed him with Chronic Motor Tic Disorder last year...which obviously we now know he DID NOT and DOES NOT HAVE (uuugghh and I even asked this Neurologist about PANDAS several time and always the same answer...no, so rare, etc). Our broker told us he would probably be denied so we kept him on his own policy since he was in essence grandfathered in. Ironic huh?!

[tpotter]

Thank you. I'll give it a try.

[Steve Council]

My son was diagnosed with PANDAS. After a series of 3 consults, Dr. K has said that IVIG was the only treatment option for him. BCBS says the use of IVIG for the treatment of PANDAS is "experimental" and has initially denied all portions of the procedure BUT they are leaving the door open by saying they consider approving claims on a "case by case" basis depending on how the doctor codes the treatment and depending on medical necessity. I have sent countless emails to Dr. K's office because I want a copy of the letter of medical necessity that he wrote to the insurance company back in April/May but only a few emails have been replied to and my questions regarding insurance codes and other requests have gone unanswered. His receptionist tells us last week that we don't have a right to a copy of the letter! What?

 

I'm getting equally frustrated with Oakbrook Surgical Center as well. Of course, they want their money upfront too. Their attitude is just pay us...and file an appeal with BCBS later. Sorry, I want my son well again, but that just seems like a irresponsible response. OSC won't make a single call to BCBS to answer questions that they have regarding treatment codes. All this seems odd to me.

 

Let me say that we absolutely adore Dr. K. My wifes family has known him for almost 40 years. I'm just really confused why we cannot get any cooperation here. To say that we dont have a right to a copy of a letter is simply ridiculous!!!! I know the doctor is busy, I appreciate that. We have been waiting since April though. Something is not right.

 

I've decided to hire an insurance advocate to step in as I've run out of options.

 

Any advice is appreciated.

 

Steve