Insurance board?

[gijanet]

Don got a call from the QAS folks. Everything is cleared with Katie's PC and all the forms filed. The rep said our only holdup was my insurance company, Blue Cross BS (fill in the missing letters; if you are thinking Blue Shield, you're wrong............heehee! ). It was pending and had to go before "the board." Anyone want to shed some light on this? Thanks, as always. Janet

 

[Ross]

Sounds like a stall tactic until they can say denied.

 

[jeffp]

I also got BS from BS. The "board" is a panel of nurses that goes through the policy coverage manuals to see if this item or service is specifically excluded (their jobs seems to be to justify saying NO). The home testing units are so infrequently used, that they are never mentioned specifically. It will then go to the medical director for approval or disapproval on an individual basis. I had a 2 month ongoing process with my carrier to get the item approved. I personally know the nurses and medical director at the local BS office after years of dealing with them from the "other side" of the process. Still had to send the medical director copies of medical journal articles and the local Medicare policy on home testing advantages (cost-wise) for valvers. It was a long drawn out process that should have been a 1,2,3 deal.
Keep pushing at 'em. Don't be afraid to make LOTS of phone calls to follow up.

 

[catwoman]

Janet:

Jeff's got some good points and you might want to be ready with copies of studies on home-testing, etc.
Perhaps the fact that Katie is a child, as opposed to an adult whose diet, exercise levels, etc., may be more stable, could tip the scales in your favor. I would certainly push that point.
Wonder where you could get some anecdotal info from someone who has children/juveniles in their anti-coagulation management practice? Hmmmmmmm.

 

[gijanet]

Well, shoot, y'all! (notice the comma in there, please!)

Well, shoot, y'all! (notice the comma in there, please!)

That's exactly what I was afraid that meant. I'll stay on top of it, but, geez, Jeff, if you had to wade through the BS quagmire for two months, and the local office knew you, I can hardly wait to find out what kind of BS we get to lowcrawl through...........argh! I don't suppose you have any of those links handy, do you? Guess I will have to get my ammo ready. Thanks mucho. Janet

 

[Natanni]

Links!

Links!

Ditto that on those links Janet!

We bought Nathan's INRatio outright from QAS because he needed to be comfortable with it by the time he went back to work post surgery. After several attempts of talking with our local union rep for insurance company, she finally understands that we can not go running to the pharmacy for supplies. Really don't understand how all this will pan out, but any advice on being prepared will be appreciated

 

[Sagebrush]

I also had bc/bs and I started the process in July of 03 and finally got approved in November or December of 03...so it does take awhile with them.

 

[Lorraine]

I too am on BC/BS. I have tried once to get the machine and became very discouraged. I am going to try a second time now. If I have to I pay for the machine myself, but I would like BC/BS to at least pick up the supplies.

Hey Sagebrush. What arguments were you able to use to get them to aprove it. I'm in Illinois, and I have heard from others that Illinois BC/BS seems to be the worse with wanting to pay for the machine.

 

[GaryReece]

Insurance and QAS

Insurance and QAS

Don got a call from the QAS folks. Everything is cleared with Katie's PC and all the forms filed. The rep said our only holdup was my insurance company, Blue Cross BS (fill in the missing letters; if you are thinking Blue Shield, you're wrong............heehee! ). It was pending and had to go before "the board." Anyone want to shed some light on this? Thanks, as always. Janet

I have united Health Care through the State of Az as my wife is a state employee. My doctor had to go to bat with the Medical Director of United Health Care (who originally declined my claim) to get me my QAS monitor. Insurance wanted to go with a cheaper low quality monitor. It took one phone call from my doctor to my insurance and my QAS INRatio monitor was on the way. The whole process took only 2 weeks. Don't be afraid to ask your doctor to get involved, for me that was all it took. I received a St Judes Mechanical Aortic Valve 8-10-2004.

 

[Sagebrush]

Lorraine....I beleive Micheal from QAS was the one who got everything approved....I beleive he told me that because I have a lifetime need that they had to approve me because medicare has passed that rule that if you have a lifetime need it is in yours and their best interest that they approve it and uaually BC/BS goes by what medicare does. Maybe it has to do with the type of plan you are on....I don't know....why they would deny you when I see you have a life time need also...I hope you get one....keep on fighting!!! Maybe you had a new person at QAS and he/she didn't know all the ropes yet...Contact Michael and see if he can help you....he was my lifesaver!!!