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Originally Posted by 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.  |
Don't worry, take it one step at a time. Don't get frustrated, as they will always deny first and hope you'll disappear. DO ask for a reference/confirmation number for every conversation you have with BC/BS...this will enable future reps to pull up your notes. (yes, you most likely will have to call many times) DO ask what call center you are speaking with as well. When you call initially, DO ask them what steps you need to do to appeal. DO have them fax you the form to complete. You will probably be told that appeals can take up to 60 days. DO follow up during that time to check on the status. If denied a second time, I would recommend appealing again. DO contact the ADA as soon as possible to find out if you are declined if there is anything they can do to help. GOOD LUCK! (I'm currently on a second appeal with some charges for my boss-we have Carefirst BC/BS) I'm also in the process of researching other insurance options for our company, but unfortunately being in DC and being a small company, we really only have 3 options, and none of them are ideal. My experience with other insurance is the same, though, they all will do whatever they can to deny, or cover at a lower rate and wait to see if one will challenge it.
Cyn
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