Blue Cross Reimbursement of Coaguchek/Protime supplies

[LUVMyBirman]

Need some pointers.

I carry Blue Cross and they informed that covering my Coaguchek supplies would not be an issue. As I have noticed with a few members here at VR.com that carry BC.

Submitted my claims and they bounced them back. Don't know how much more I can offer than an original recepit and a detailed claim form.

Any tips? Pretty new to BC. I have been paying out of pocket for the past 3+ years. Save them so much in lab fees. I feel it's high time to see some benefits!

Going to give them a ring again.

Thanks.

 

[ALCapshaw2]

The standard way to get BCBS to cover something 'new' is to submit a claim, have it rejected, and then file an APPEAL.

There is NO WAY to file an APPEAL before the fact.

Good Luck!

I'm in that very process now

'AL'

 

[Lorraine]

Gina,

I have BCBS PPO. They denied me twice for my Protime Machine. I did appeal and they still denied me. I'm thinking of trying again since I know BCBS in other states have okayed paying for the machine since I've been denied. I just can't undertand why the insurance company wouldn't think it would be important to home monitor your INR on a weekly instead of a monthly basis, since it's Rat Pioson we're taking. I agree with Al. Just keep trying.

 

[LUVMyBirman]

Thank you Al and Lorraine.

Took a closer look at the EOB and they did cover my supplies. Applied it to my deductable for the year. Was confusing as there was a claim for another household member on the back. Very strange.

Lorraine, if your policy has a rider for "durable medical equipent" these such supplies and equipment are covered at 80% on my policy. Just takes a quick call to see if you have such a coverage. Sounds like we are on the same plan. Should not be an issue. You may have to pay for your machine and seek reimbursement. First corner someone at BCBS and ask them to give it to you in writing.

Or better yet, QAS handles that for you all correct?

 

[QAS Lance]

BCBS

BCBS

Hello Gina,

I'm sorry to stick my nose in here, but I know the reason why you haven't gotten covered. QAS has learned that BCBS of Illinois will not cover the PT/INR home supplies under the DME portion. You may have to bill it under an IDTF, following the same guidelines as Medicare. This requires weekly testing, support of physician, and monitoring service provided by and IDTF (like QAS). They tell me that you are NOT guaranteed to be covered under the IDTF, because of their rules, but we would be willing to help you. We have a new department that works specifically with new Coaguchek patients. If you are interested in hearing more, send me and email, and I'll forward your information to the QAS Coaguchek team. Hope this helps, and thanks,

Lance, QAS

email: [email protected]

 

[LUVMyBirman]

Hi Lance,

Yes, and thank you! Have a few more questions. Appreciate the assistance.

For the everyone else here caught up in the vicious cycle.....this is what I gather from my EOB.

My "reimbursement" was applied to my 'out of network deductable'? Then, at the bottom of the EOB it states total beneifts approved -$0.

So, what was actually covered?

 

[RobThatsMe]

Hi Gina,

Ahhh... such a timely question you have. I have been going round and round with BC for months on this.

My old company had a different insurance, and I didn't have to deal with BC. All my testing expenses were always paid.

Now with this new company, they have BC. The problem I had the first time I purchased supplies lasted 7 months. I bought a box of testing couvettes, 25 to the box. BC covers durable medical supplies, but had no code for this item, so they coded it as a diabetic test strip which only paid a fraction of the cost. It took months of phone calls to straighten this out. I must tell you that QAS fought hard for me, and their support person Debbie Tan spent many hours helping me. She finally got a supervisor there to hard code some info in to my file to prevent this from occurring again.

Well.. just about the time I had the first claim straightened out, it was time for me to purchase another box. Even though the box had 25 test strips.. the claim was filled as "1 box" they paid for 1 test... Grrrrrrr... The claim did have 25 test strips in the discription... sooo I am back to battling this same problem this morning.

I figure a few more times and maybe the Blues will have this coded correctly for me and avoid this issue in the future.

 

[QAS Lance]

Hello

Hello

Gina,

I don't work for the insurance department here, but I know we cannot get any coverage from BCBS (Illinois) under the DME insurance. However, you might want to try using the IDTF model, which would require weekly testing, but at least you could get your supplies taken care of. I think you should speak with Michele Grogg, who now supervises the QAS Coaguchek department. I don't want to misinform you, and I am going to give her your name. You should at least see what's available, as any home testing supplies can be costly. I cannot guarantee you will be covered, but they told me there is a possibility. Thanks,

Lance

Email:::: [email protected] and mention my name.

 

[LUVMyBirman]

Thanks so much Lance. Just zapped an email off to you. I do test weekly....so this may work out.

 

[Raverlaw]

This is something I have been wondering, as we are on Blue Cross PersChoice. Since I am not yet post-op, I haven't gotten around to asking them, but it seems to me that more frequent testing = good and will save them a bundle on blood draws over the life of the machine.

I'd be interested in hearing from anyone who got BC to pay for a machine...

 

[ALCapshaw2]

BCBS has 'Case Workers', typically nurses, who handle 'special cases' that do not fall under 'normal coverage'. For instance, some policies do not offer Cardiac Rehab as standard coverage but may arrange for it on a case by case basis by writing an individual contract. A case worker was responsible for obtaining coverage for my Protime Monitor. One of the BCBS representatives gave me the contact information for obtaining a case worker.

'AL'

 

[QAS Lance]

BCBS

BCBS

We have found that BCBS veries by state, and some cover and some do not. However, the new IDTF formate has become pretty successful. This is the same model that Medicare (CMS) uses for their valve patients. Anyone with BCBS who has questions, please call QAS, because the answers are different by state. Thanks,


Lance, QAS

[email protected]

 

[Gisele]

BCBS of MA

BCBS of MA

I got BCBS of MA to purchase my machine and supplies before it was an approved item. I had to go through the appeal process but BCBS was very helpful in guiding me through what and how needed to be done as the case worker felt I was an excellent cadidate for a Protime unit. My coverage was at 100%.

The following year BCBS of MA had approved coverage of these units and supplies and that is when I ran into problems. Because the claim no longer went to the appeals dept it seemed as though the claims dept didn't seem to know how to handle this. I did manage to get 100% coverage (I would buy two boxes at once). There was a lot of going back and forth and I did have to place a lot of phone calls each time. There just really seemed to be a lot of confusion as to how this item without a specific code should have been listed and paid for.

I have been very lucky with BCBS of MA and I do find that they are very helpful whenever I call about anything. I don't miss submitting those claims though for reimbursement of supplies. Guess it is one of my perks of now having a bovine valve...

 

[delaluz]

Ptinr monitor

Ptinr monitor

I have been going crazy with this issue for months now. BCBS HMO gives you bites and pieces and though they say they can help...they don't really. If anyone can show me the light, I would be most grateful. The stress level has been doing a number on my blood levels. Thanks.

 

[Karlynn]

It really depends on who your BCBS is with. All BCBS are not created equal. My BCBS covered everything, and yet 40 minutes away, LUVmybirman's turned her down.

I would start out by asking for a nurse case manager at BCBS to call you. If you can get them on your side, you will have a chance. My nurse case manager said "Well of course you want to home test!"

If BCBS is not willing to pony up, but your doctor is willing to let you home test - some companies will discount the machine. You purchase it directly and see if BCBS will cover it as an out-of-network expense.

I know these little puppies are expensive. But I will give up a lot of things before I ever go back to lab testing. It's that important to my health and safety as a Coumadin user and that important for me to be able to live my life normally.

Best wishes and welcome!!!!

 

[ALCapshaw2]

When I was trying to get coverage of my Test Strips through my company's Home Office (in another state) I never could find anyone who even knew what "anticoagulation" was and there seemed to be NO interest in providing the coverage.

It also appeared that BCBS has separate guidelines / rules for EVERY STATE. QAS tried to get National Coverage at one time. I have no idea how that turned out. You may want to call QAS and see where they stand with BCBS now.

GOOD LUCK !

'AL Capshaw'

 

[Karlynn]

Al - I think it's still the same. Gina had, I believe, BCBS of IL, I had Empire BCBS. Mine was no problem - and she got turned down.

It was VERY frustrating for me when QAS was not "in-network" for me. The BCBS 800# gave me a long list of their in-network DME suppliers (durable med equip). I stopped calling them because most of them had no idea what an INR home monitor was.

 

[delaluz]

Thank you Karlynn and ALCapshaw2 for your advice. I got your informartion and immediately call Carefirst BlueChoice (VA) and asked for a Case Manager. They refused to send me to one; however, they gave me a list of in-network suppliers and found one that had the CoaguChek monitoring meter. It appears the process is in motion now. Let see what happens but I think i can see a light at the end of the tunnel. THANK YOU very much for your input.

 

[Eva]

I'm just wondering if BCBS can deny the meters and test supplies for 'pre-existing' conditions?

Judging from these postings, that doesn't seem to be an issue.

Just curious....

I do not think so...my hubby was already diabetic when joined Anthem BC and they were very nice.

 

[catwoman]

My guess is that whether various BCBS subsidiaries cover INR testers & supplies may be based on the way that policies are written for each employer.

I ran into this with United HealthCare. It covered my ProTime 3, but not testing supplies unless they were coded E1399 (DME), which they technically probably are not. I asked a rep if diabetic testing supplies were covered under the policy. Yes, I was told. But INR testing supplies were not mentioned, so they weren't covered.