Blue Cross Reimbursement of Coaguchek/Protime supplies

[Taysgrama]

We have Anthem BCBS Ohio and they paid for my tester as well as my test strips under the DME portion of our policy. I just called QAS and they took care of everything. In fact, I just called them last week to order more test strips and they are coordinating everything with my insurance company.

In regards to getting coverage when you change employment, from what I have gone through, I can tell you that if there is no LAPSE in coverage from the time you leave your old employer and start your new employer (and your benefits start) that they cannot deny you coverage. You may have to self pay for your (current, from your current employer) insurance during the time you are not going to be covered by your new employer but you can drop that coverage as soon as your new insurance is in effect. At least that has been my experience.

 

[dick0236]

BCBS and home testing

I spent a career (25years) as an agent/consultant of Group Health Insurance. BCBS was one of the primary insurers I dealt with and I understood how to deal with them......until I got involved a couple years ago with INR home testing . I am on Medicare and have a mechanical valve, so I meet all the criteria. I dealt with Raytel(INRatio) for about six months a couple years ago. I got all the necessary paperwork completed, got the written approval from Anthem BC and then spent six months trying to get my claims paid. Finally got so disgusted, I sent the machine back to Raytel and called it quits with home testing. I did eventually get the majority of the outstanding claim paid.

I currently go to my docs office every two weeks for a fingerstick and I have -0- copay. Because of the success that many of the people here have with home testing, I have decided to look at it again and my doc has just completed the forms to be sent in. This time I am going to look at QAS to see if they are any better than Raytel. I am not sure that I will go thru this again, especially since it costs me nothing, but a little time, to get my INR checked at my docs office. However, it is a little more convenient to home test.

 

[olefin]

I am on Medicare and have a mechanical valve, so I meet all the criteria. I dealt with Raytel(INRatio) for about six months a couple years ago. I got all the necessary paperwork completed, got the written approval from Anthem BC and then spent six months trying to get my claims paid. Finally got so disgusted, I sent the machine back to Raytel and called it quits with home testing. I did eventually get the majority of the outstanding claim paid.

Dick, I'm sure you have read some of my post how simple it is to get Medicare to cover the cost through QAS. I was approved within less than a week. I think you will like QAS. I have, but only been home testing a short time.
I also have Blue Cross supplemental.

Back for 2 years after I had AVR we traveled all over in our motorhome. I would get INR test in a different town every month. Only once in a small town at a small hospital they did a fingerstick and used a INR meter. All the others were run in hospital labs.

 

[Cris N]

I don't have BCBS - I'm with UHC. But I have a similar issue. When I first wanted to get the monitor (INRatio) UHC said no on the purchase but happily agreed to do the lease program with Raytel (now Philips) - this includes the use of the monitor, the testing supplies and the weekly phone in/report to my doctor. So, they've been paying $140/month for 3 years. That comes to $5,040. Now, according to my math if they had paid for the monitor up front - let's say $1600 and paid for the strips $1,000 (generous figure) & lancets $25.00 for 3 years that would have come to roughly $2,625. So, they've paid almost double. How does this make sense?

 

[catwoman]

I don't have BCBS - I'm with UHC. But I have a similar issue. When I first wanted to get the monitor (INRatio) UHC said no on the purchase but happily agreed to do the lease program with Raytel (now Philips) - this includes the use of the monitor, the testing supplies and the weekly phone in/report to my doctor. So, they've been paying $140/month for 3 years. That comes to $5,040. Now, according to my math if they had paid for the monitor up front - let's say $1600 and paid for the strips $1,000 (generous figure) & lancets $25.00 for 3 years that would have come to roughly $2,625. So, they've paid almost double. How does this make sense?

Cris:
Have you run the numbers past UHC and asked at what point do they deem it more cost-efficient to buy the DME rather than continue to rent it? A patient with a mechanical valve is a different case from one who is on warfarin for a-fib.
When John was DXed with sleep apnea, he had to rent the machine through insurance, with him having some co-pay. At some point, his insurance company decided it was cheaper for insurance company to buy the machine outright, with him paying another co-pay.

I would pursue this angle with UHC and see if there's a sharp knife in their drawer, so to speak.

 

[Lynlw]

Cris:
Have you run the numbers past UHC and asked at what point do they deem it more cost-efficient to buy the DME rather than continue to rent it? A patient with a mechanical valve is a different case from one who is on warfarin for a-fib.
When John was DXed with sleep apnea, he had to rent the machine through insurance, with him having some co-pay. At some point, his insurance company decided it was cheaper for insurance company to buy the machine outright, with him paying another co-pay.

I would pursue this angle with UHC and see if there's a sharp knife in their drawer, so to speak.

I agree it is worth asking about this. When Justin was about 2 he needed a nebulizer for asthma. BCBS wanted to rent one. I called and explained since Justin was only 2 and would probably need this for decades at least, (even IF he did outgrow the asthma) HOW many thousands of dollars would they be wasting, instead of just buying us the machine outright. I had to talk to a manager, but she did see my logic and over rid it so they bought the machine. He doesn't use it often a couple times a year, so IF they rented it they would still be paying monthly for almost 20 years.

 

[Cris N]

I would dearly love to talk with someone at UHC about it but I can't get past the 1st or 2nd layer. When I first started in on this project I dealt with a Care Coordinator but when I ask the customer service people about it there's this long pause and then they say, A What?

I think what I should do is go through the process of trying to get it outright and see where that goes. All in all, I'm not dissatisfied with the service I get (now that Philips and UHC are on the same page about being in-network) and in 4.5 years I'll be eligible for medicare anyway!

 

[ALCapshaw2]

I would dearly love to talk with someone at UHC about it but I can't get past the 1st or 2nd layer. When I first started in on this project I dealt with a Care Coordinator but when I ask the customer service people about it there's this long pause and then they say, A What?

Have you asked to speak with a Manager?
You've got to get past the people who are only authorized to say NO!

If you keep getting NO's, keep asking to speak with that person's supervisor until you get to someone who can actually help you.

Good Luck!

 

[Cris N]

I managed go up one level which, quite frankly, didn't really accomplish anything. The cynical side of me says they take turns being a line supervisor

It's so frustrating these days trying to conduct business with any large company these days... first going through the phone tree, then waiting for the next available customer service rep - but, thank heaven, my call is very important to them

Grrrrr.....

 

[Eva]

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.

Hi, I did not read the post replies as I just got back from church a while ago and wanted to add a comment or ask you if you or your doctor mentioned the diagnosis code...this is essential to approve the machine and test strips...at least in my case when I first asked them if they would approve it, their answer was to have the doctor write the diagnosis. I never called...I always exchanged messages via internet.

 

[LUVMyBirman]

Wow, this is an old post. With current issues! I have gone rounds with BC and nothing. My INR is not always within range. So they deny the supplies and a unit. They want the INR in range for 3 tests before they will approve. If I were in range...would not need the unit as much. I am too tied of the BS to deal with it. When I am in the proper frame of mind and have the time...will go for it once again.

 

[lilteach3234]

My husband and I both have BCBS and I am double covered. What we have both found is talking with our case manager. If you let your case manager know things that are going on, it really seems to help. We've had alot of equipment covered.

 

[ShezaGirlie]

A suggestion..

A suggestion..

Might I suggest that you create an online account with BCBS, Humana or whomever and use the 'contact function' while signed into your account.

Send them an e-mail and get the ball rolling again. Seems they are more accountable when it's the 'written word' they're dealing with even though it may be a different person responding to you each time. Kinda difficult for a CS rep to deny they said something or you said something when it's all in your record in black and white.

I just got an out-of-network approval without speaking on the phone to anyone at Humana..

 

[njean]

We have BCBS of IL through my husband's employer & I have never had any problems getting reimbursed for my INR home monitor supplies whatsoever.

Initially when I got my INRatio 2 machine from QAS, my doctor filled out the Rx for it as requested by QAS & then QAS contacted BC & BCBS of IL paid for everything.

When I order my strips or lancets, QAS bills my credit card, they send me a receipt & then I turn around & fill out the Insurance Claim Form & send it along with the receipt to BCBS & then wait for my reimbursement from the ins co.