[-sammy-]

im having one of these on monday i think.

you might have to pay for it :\ ekkk

its so much aswell.

im glad i live in the uk because a lot of the prescritons and stuff are so expensive

[cyberus]

Appeal AND file with the state insurance commision.

[Tony]

Originally Posted by gettingby

As some of you may know, I recently did a 3 day CGMS run. BCBSNC has denied my claim.
Reason for denial:
Request for coverage of 72-hour interstitial glucose monitoring is reviewed. Per Corporate Medical Policy BCBSNC will not provided coverage for continuous monitoring of glucose in the interstitial fluid. It is considered investigational and BCBSNC does not cover investigational services. Deny request for coverage as not medically necessary.

I honestly do not believe my endo would have suggested this to me if he had not thought it was medically necessary. The results he received from the monitoring is helping him to figure out why my A1C's have been staying high.
My question is this. Appeal or just let it go and pay the bill myself?
Thanks everyone for your opinions.

I would definitely appeal!! Blue cross covers the use of the three day wear from the Dr's office. Not only that they cover this to two times in a calendar year. I'm guessing they must have entered in the wrong billing code as they do not cover long term use.(as of last year any way.)

Good luck and do keep us posted.

[gettingby]

I am definitely going to appeal. It's not the money, it's the principle of it. Why should we have to pay for something temporary when we have to pay so much in the long run. My endo is going to help me out with this and if all else fails, it's on to the Insurance Commissioner.

[EazyE77]

Bleh darned stupid insurance companies! Appeal their stupid arses. Things like this should be covered. This is exactly what is wrong with the healthcare in this country, everyone trying to make a little extra cash. You're right Cin, youpay $14 over what the cost of that 3 day CGMS cost in your weekly payment to the silly gooses and yet they have the nerve to deny a claim to pay? Some of these cooperate jerks need a real kick in the cans. Sorry for the rant just giving my opinion while having some emotional troubles myself lol. Best of luck to you in this.

[cyberus]

Originally Posted by gettingby

I am definitely going to appeal. It's not the money, it's the principle of it. Why should we have to pay for something temporary when we have to pay so much in the long run. My endo is going to help me out with this and if all else fails, it's on to the Insurance Commissioner.

IMHO

DO NOT WAIT to start a file with the state insurance commission. If you wait until you lose the appeal with the insurance company you may have to wait 3-6 months more for them to act.
Look at the state commission as a "alternate appeal route" rather than the next level of appeal.

[Cloudedbrains]

I maybe from the UK but I had also to appeal about an issue with medical care (yes we dont pay but there are still pompous people who dont understand how something can help a person) so I say APPEAL and dont let them grind you down !!

The money these companies make it will cost them less just to pay for it, as if you take it as far as you can in an appeal it will end up costing them more !!

[lelggren]

The dr's office that the insurance was billed from is probably already in the appeals process with this. I work in a clinic, and when we get an EOB stating that something came back as not medically necessary, we automatically just start the appeals process with the insurance.

[ant hill]

Originally Posted by gettingby

The results he received from the monitoring is helping him to figure out why my A1C's have been staying high.
My question is this. Appeal or just let it go and pay the bill myself?
Thanks everyone for your opinions.

Aww Cindy , You know I like you as to do try to get the BG's to better control and this fantastic tool that makes diabetes manageable. Cindy get your gun as the gunfight will begin LOL
Insurance companies get paid by us to get help wherever we need them and this is needed to get some answers about control. Good luck darl'in. ((((HUGS))))

[terryok123]

i have appealed and ended up at a third party out of state arbiter who reversed the insurance company's decision... they PAID...LOL.. the xxxxxxxxxxxxx it was not for a pump though.

[Dewey]

The more I think about it, the more I agree that cyberus is right. I think going to the state insurance commissioner is probably going to be the best way to get the help needed. Appeals can take time & sometimes, things don't pan out the way they should. I'd like to know how things work out. When I hear about all the trouble you've encountered in NC with everything from insurance coverage to getting supplies, it makes me Never want to move there!

[gettingby]

Originally Posted by lelggren

The dr's office that the insurance was billed from is probably already in the appeals process with this. I work in a clinic, and when we get an EOB stating that something came back as not medically necessary, we automatically just start the appeals process with the insurance.

I didn't know they would do this Laura Anne. I've never had to appeal anything. My insurance has always paid before.
This is a new policy/insurance coverage so I'm wondering if that is the reason for the denial or if it was simply just them inputing the wrong code.

[notme]

I would call your insurance company and ask them the reason for the denial Cin. Many times they will resubmit your request and it will go right through. I have had this happen on at least three different occassions.

[gettingby]

Well, it looks like I have to go about the appeal process on my own. My endo's office will not appeal BCBS because they have not been able in the past to get them to pay for the 72 hr CGMS. Also, the insurance commissioner will not do an external review because the city self funds their insurance. I'm going to call BCBS tomorrow and see if someone will listen to me.
I've never had to appeal anything so I'm not sure how to go about doing it.

[ant hill]

Originally Posted by gettingby

I'm going to call BCBS tomorrow and see if someone will listen to me.
I've never had to appeal anything so I'm not sure how to go about doing it.

Hey Cindy, May I pass the best of luck with you and be well. (((HUGZ)))