Has anyone done this?

[Perrster]

I am currently in the process of writing an appeal letter to my insurance provider because they have denied me coverage for a Protime unit. I will be getting additional support from my Cardiologist, but I was wondering if anyone has had to go through an appeal? If so, could I please borrow some words of wisdom from you? I'm having trouble wording the letter and keeping it non-emotional.

Their primary reason for denial is that I am "not homebound and Phlebotomy or fingerstick testing can be obtained in an out-patient setting."

Thanks.

 

[Granbonny]

Make it a money issue?

Make it a money issue?

Perry, I was so lucky. My insurance, Unitedhealth granted me one right away after receiving all the paperwork...I had in mind to use this on them if I had any problems. I know it cost $54.00 a draw..and I was going to say..Every 2 weeks..26 times a year times $54.00...Would pay for a Protime in 1 year..and I will be lifetime on Coumadin...Don't know if it would have worked or not. Just got real luckyI guess. Bonnie

 

[Christina]

Hi Perry,

Becky from QAS and I went through 4 appeals with my Insurance Company. (Health Net of Arizona)
I mainly used the cost issue and how much money they would save by granting me this machine. I made a spread sheet for them. One side I listed their cost if I were to go to the lab all the time (I was going up to three times a week) and the other side the protime cost plus supplies. Per week, per month, per year, per lifetime.
I have no idea what Becky wrote to the insurance company. I am sure she did a good job as they all try very hard, but they denied me four times and four times was the limit.
The doctor I had at that time refused to say that this machine was medically necessary because he didn't believe that it was. I tried to reason with him but without success.
I now am with a different Insurance company as of 7/1/02 (Pacific Care) and am wondering if I should try again just to get them to pay for the supplies. I've had the unit now for 18 months with my new doctors blessing, but am buying all the supplies out of my pocket. I already would be happy if they would pay for the supplies.

Hope you get lucky!

Christina
AVR's 8/7/00 & 8/18/00
Aortic Stenosis
TMC Tucson, AZ
Dr. Gulshan Sethi

 

[Gail in Ca]

I was the first person to ask for a protime unit and my insurance just needed to know from my cardiologist that it was 'medically necessary'.
I believe this is the key to coverage.
Mine ended up being covered at 80%, supplies the same.QAS handled all the paperwork, from getting the letter from the Doc to dealing with my insurance.
Good Luck!
Gail

 

[RobThatsMe]

Hi Perry,

The main reasons sited when applying for coverage were: 1) I was required to have INR testing every 2 weeks for life. 2) My job requires travel it was difficult to see my doctor and test while away from home. 3) The cost savings of using a home unit versus lab over the course of time.

Lance a QAS filed everything for me. Also, I did contact the nurse at the insurance company and spoke with her about my case. She was on the review board. I also composed a letter stating my reason for requesting the unit, and sent a copy to her, and a copy to Lance to use with his filing.

Also, after I received mine, another person in my office requested one. She was denied several times, but finally got it covered.

Good luck!

Rob

 

[ALCapshaw]

Has anyone received insurance coverage "after the fact", i.e., after paying for a home testing unit out of your own pocket?

'AL'

 

[arlenef]

Protime unit

Protime unit

About 2 years ago, I was successful in convincing my insurance to pay for my Coagucheck Protime machine. I had to write several letters and then go before a review board. They said I could send a representative, but I felt I could do a better job of explaining myself. At the time, I did a lot of research on the internet. I found all I could on studies that have been done that show that people who use these machines get into less trouble than people who go to a clinic or a lab. The reason for this is of course that you check it more often. I pointed out the cost of treating someone with a stroke or a severe bleed versus someone who is testing frequently and keeping their protime in check. I also got information on the cost of the lab tests to the insurance company versus the cost of the test when I do it at home. I made copies of all of my information for the members of this committee. I was 56 at the time and felt that I, like a diabetic, was perfectly capable of testing myself and working with a clinic to learn how to adjust my medication. Within the hour, they had agreed to pay for it. I agree, don't get emotional. Stick to the facts and the research you can find. At the time I got mine, Medicare was not paying for the machines, but it could be that Medicare is paying now. Good luck.

 

[ALCapshaw]

Home INR Testing

Home INR Testing

Perry,

Did you see my Private Message to you on this topic?

'AL'

 

[Guest]

Christina,

Glad to see that Pacific care paid. Some of my patients pronounce the name

P - A - SEE IF I CARE

 

[EVELYN]

PROTIME AND INSURANCE

PROTIME AND INSURANCE

HELLO ALL...AFTER READING ALL YOUR POSTS, I'M JUST HOPING WE DON'T END UP IN "INSURANCE HELL!!" LANCE JUST RECEIVED ALL OUR PAPERWORK FROM THE CARDIO, THE LETTER OF MEDICAL NECESSITY AND SCRIPT, ETC. ETC.....DOES ANYONE HAVE ANY IDEA HOW LONG IT TAKES TO HEAR FROM THEM?? WE DO HAVE ONE CONTACT WHO HAS BEEN AN ANGEL FOR TYCE FROM THE FIRST AFIB THROUGH THE SURGERY AND BEOND....SHE IS ACTING ON OUR BEHALF AND GOING TO THE INSURANCE COMPANY FOR US.....HOPE IT WORKS.

THANKS FOR ANY ADVICE YOU CAN GIVE US.

EVELYN