Guest guest Posted October 26, 1999 Report Share Posted October 26, 1999 Carla: Where did you get your info? I received a copy of my benefits statement yesterday informing me they were paying the hospital bill so I feel pretty sure they will pay the IR too. The IR contacted BCBS prior to the procedure and were told there would be no problem with coverage. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 26, 1999 Report Share Posted October 26, 1999 Got the info from IRs at the UFE conference. " Experimental and investigational " is how the majority of policies still read. Means a case by case review and not carte blanche coverage. Many women are still going through the denial and appeals processes for reimbursement and many more are simply sitting in queue waiting for approval while they appeal their pre-cert denial. By and large BCBS is NOT covering this procedure based on the statement that it is still " experimental and investigational " but every single policy is written differently. Also, even when the policy states it is " experimental and investigational " a LOT depends on how the gyn has written up your case record. If there has been a systematic review of symptoms and attempts at multiple methods of treating those symptoms well documented in your medical records AND hysterectomy is documented as not being desired (for whatever reason) AND myomectomy is also documented as not being appropriate for some reason (like the woman doesn't want to risk the abdominal surgery, can't miss that much work, doesn't want to take a chance that it turns to hyst, doesn't want blood transfused, etc.) THEN BCBS usually will cover the procedure regardless of the policy statement of " experimental and investigational. " Also, they like to see menorrhagia and anemia documented and low hematocrit that doesn't respond to iron supplementation. All of those things well documented on your medical chart by a gyn will generally get you approval. Goodwin said BCBS hasn't covered a procedure in California for months -- only rarely and well documented cases. Other IRs indicated the same. If yours was covered with no problem, can you tell us if your gyn documented all of the above on your medical chart (if you've seen it, that is)? Also, where or what city/state are you located in? carla >Carla: Where did you get your info? I received a copy of my benefits >statement yesterday informing me they were paying the hospital bill so >I >feel pretty sure they will pay the IR too. The IR contacted BCBS prior >to the procedure and were told there would be no problem with coverage. > > > >------------------------------------------------------------------------ >Cell Biology Reference Set-3 books + 2 CDs-for >$7.99! A $127.40 value, yours with membership >in Library of Science, the leading science book >club since 1958! Order NOW at >http://clickhere./click/1369 > > >eGroups.com home: /group/uterinefibroids > - Simplifying group communications > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 27, 1999 Report Share Posted October 27, 1999 I am under the Pa. Blue Cross/Blue Shield HMO Keystone and my UAE was covered 100%. My IR said that it took him a bit to convince the doctors and I'm fairly certain not all the criteria you outlined were documented in my chart. I do know as a patient I could not call and find out if the procedure was covered. I was told by the customer service rep (I guess that's what they are) that the procedure was too technical for her to tell me if it was covered. I do not have a full copy of the policy to see how UAE is covered. I feel for everyone having a fight with the insurance company. I know I counted my blessings when it went along so smoothly. By the way I did have the procedure done at a Hershey Medical Center (Acturally, I think it's now called Penn State Geisinger) that was part of the HMO group, but I did go out of my service area. At 07:14 PM 10/26/1999 -0700, Carla Dionne wrote: >Got the info from IRs at the UFE conference. " Experimental and >investigational " is how the majority of policies still read. Means a case >by case review and not carte blanche coverage. Many women are still going >through the denial and appeals processes for reimbursement and many more are >simply sitting in queue waiting for approval while they appeal their >pre-cert denial. By and large BCBS is NOT covering this procedure based on >the statement that it is still " experimental and investigational " but every >single policy is written differently. > >Also, even when the policy states it is " experimental and investigational " a >LOT depends on how the gyn has written up your case record. If there has >been a systematic review of symptoms and attempts at multiple methods of >treating those symptoms well documented in your medical records AND >hysterectomy is documented as not being desired (for whatever reason) AND >myomectomy is also documented as not being appropriate for some reason (like >the woman doesn't want to risk the abdominal surgery, can't miss that much >work, doesn't want to take a chance that it turns to hyst, doesn't want >blood transfused, etc.) THEN BCBS usually will cover the procedure >regardless of the policy statement of " experimental and investigational. " >Also, they like to see menorrhagia and anemia documented and low hematocrit >that doesn't respond to iron supplementation. All of those things well >documented on your medical chart by a gyn will generally get you approval. > > Goodwin said BCBS hasn't covered a procedure in California for >months -- only rarely and well documented cases. Other IRs indicated the >same. > >If yours was covered with no problem, can you tell us if your gyn documented >all of the above on your medical chart (if you've seen it, that is)? Also, >where or what city/state are you located in? > >carla > > >>Carla: Where did you get your info? I received a copy of my benefits >>statement yesterday informing me they were paying the hospital bill so >>I >>feel pretty sure they will pay the IR too. The IR contacted BCBS prior >>to the procedure and were told there would be no problem with coverage. >> >> >> >>------------------------------------------------------------------------ >>Cell Biology Reference Set-3 books + 2 CDs-for >>$7.99! A $127.40 value, yours with membership >>in Library of Science, the leading science book >>club since 1958! Order NOW at >>http://clickhere./click/1369 >> >> >>eGroups.com home: /group/uterinefibroids >> - Simplifying group communications >> >> >> >> >> > > >------------------------------------------------------------------------ >Get A 0% Intro APR Visa with Instant Approval right now a >GetSmart.com at http://clickhere./click/1270 > > > >eGroups.com home: /group/uterinefibroids > - Simplifying group communications > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 27, 1999 Report Share Posted October 27, 1999 FYI, I had a UAE in January of this year, and was completely covered by Blue Cross/California Care. Barbara in San Diego Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 27, 1999 Report Share Posted October 27, 1999 November of last year wasn't a problem either. The problems began around early July of this year -- about a month after Carole Flamm attended the RAND/SCVIR conference on UAE. Shortly thereafter, Dr. Bruce McLucas was audited by BCBS and laparoscopies were changed from no pre-cert required to pre-cert required. Then his contract with BCBS was terminated in September. Since sometime in July BCBS has been scrutinizing all requests for UAE with much tighter scrutiny than before. They totally stand by their " experimental and investigational " policy statement and refuse to budge. They have specifically indicated that they would like to see the highest level of randomized clinical trials between uae and myomectomy completed prior to changing their policy statement. carla >FYI, I had a UAE in January of this year, and was completely covered by Blue >Cross/California Care. Barbara in San Diego Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 29, 1999 Report Share Posted October 29, 1999 Barbara: Would you consider sharing the name of the physician that performed your procedure? I too am in San Diego and covered by United Healthcare. Vicky Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 30, 1999 Report Share Posted October 30, 1999 Vicky, My IR was , who works out of Grossmont Hospital. He was great to work with. He, along with my gyn, Pyka, wrote great appeal letters to my physician's group after I was initially turned down. This was in Jan. of this year. Hope this helps...Barbara in San Diego Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 1, 1999 Report Share Posted November 1, 1999 Barbara: Thanks for the information. I sincerely appreciate having their names. Vicky Quote Link to comment Share on other sites More sharing options...
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