For Anybody who has Blue Cross, Blue Shield

A forum to discuss Chronic Cerebrospinal Venous Insufficiency and its relationship to Multiple Sclerosis.

Postby HappyPoet » Thu May 05, 2011 12:44 pm

Cece wrote:Apologies if starting that thread affected the conversation here. This news affects more of us than just those with BCBS insurance, I didn't want anyone to miss it.

Cece, your sweetness is showing - you did nothing that needs apologizing for. I linked the two threads without first asking the OPs, you and kathyj08... I apologize to you both. Please accept these smiley faces :) :)
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Postby Kathyj08 » Thu May 05, 2011 12:55 pm

No problem. Post or link wherever it will be seen and helped by most on here!
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Postby hannakat » Thu May 05, 2011 4:19 pm

So then... what is happening with Dr. Siskin's patients who have BC/BS. Anybody here have personal knowledge?
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Postby Cece » Thu May 05, 2011 4:24 pm

I'm curious about that too, hannakat.
HappyPoet, :) :), all good.
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Postby orion98665 » Thu May 05, 2011 6:13 pm

drsclafani wrote:
Again, i am willing to work as many hours as i can pull staff together in order to reschedule patients sooner. time, i believe is of the essence. anyone interested, please email kmoran@aac-llc.com


Hi DR. Sclafani as this news is very discouraging to me too; i know by the time my wife has the procedure i'll just have to pay out of my own pocket.
"So be it!" However, what about your malpractice insurance. Is there a chance Insurance company's in the future might refuse to cover IR's their
liability insurance..?? Can they..??? God i hope not!!

Thanks,

Bob
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Postby blossom » Thu May 05, 2011 6:50 pm

i just got some paper work in the mail and sisken's is just submitting some of the stuff to medicare now the way i'm reading it. i got treated aug. 2, 2010 in the hosp. i had gotten the bc/bs statements a month or so after that they had pd. if i remember right, around $22,ooo and my part owed provider was 0. then awhile later i got a bill from siskens clinic wanting money for when he ran the ultrasound up my neck to make sure i had flow -- i was in my wheelchair to get checked but lying down for angioplasty detecting my bad veins--i always wondered about that. anyway,for that brief maybe 10 min. tops the bill was "i'd have to round up the papers and my hand is too bad now but i think it was around $1,100. when i called them the girl said somehow it was not sent in and they would take care of it.. the hosp. procedure and the follow up at the clinic were separate bills

i told whoever i was talking to that whenever i was talking with them they told me it would be covered by my ins. AND as far as i was concerned they did all the checking and stuff so if they wanted paid they better get it from the ins. co. it was not my fault. then i heard nothing until the other day that some of this stuff is being submitted.

so, we'll see. ??????????????????????????????? like any of us need any more added bullshit than we have to put up with just to make it through each day!!
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Postby zinamaria » Thu May 05, 2011 6:58 pm

blossom said:
"so, we'll see. ??????????????????????????????? like any of us need any more added bullshit than we have to put up with just to make it through each day!!"

Isn't that the f---------g truth!

I am on that phone tomorrow to BCBS over here in New Mexico.
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Postby newlywed4ever » Thu May 05, 2011 6:58 pm

nellie wrote:If this BC/BS policy change wasn't effective until 4-12-11 why was newlywed4ever who had the procedure on 1-28-11 & a check to AAC cut on 4-5-11 denied? I don't understand.


Actually, the BC/BS medical policy was the last excuse (following many) AAC gave me for not reimbursing the BC/BS check to me. It really had nothing to do with this new policy. As an aside, another TIMSer was told by her IR that the policy does/did not go into effect until 5/3/11 - which coincides with my phone call from AAC and others' phone calls from their medical facility.
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Postby bestadmom » Thu May 05, 2011 7:22 pm

BCBS wil do whatever they can to avoid paying a claim.

I sued them in 1983. They paid the inpatient hospital bill on a minor surgery, denied the doctor's part ($300), which meant my major medical couldn't release the balance of the doctor's reimbursement. My major medical approved the claim.

When I filed the small claims suit, I was harassed by BC that if I lost they would rescind the hospital payment. I won because they did pay the hospital. The arbitrator had a bone to pick with them too and gave them hell in court.

So fight them if you need to. Any arbitrator, judge or jury will sympathize with you if an insurance company tries rescind what they already paid. We are the ones who need it the most and the average person is on our side, not on the side of the cold heartless insurance company.
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Postby newlywed4ever » Thu May 05, 2011 7:55 pm

bestadmom wrote:BCBS wil do whatever they can to avoid paying a claim.

I sued them in 1983. They paid the inpatient hospital bill on a minor surgery, denied the doctor's part ($300), which meant my major medical couldn't release the balance of the doctor's reimbursement. My major medical approved the claim.

When I filed the small claims suit, I was harassed by BC that if I lost they would rescind the hospital payment. I won because they did pay the hospital. The arbitrator had a bone to pick with them too and gave them hell in court.

So fight them if you need to. Any arbitrator, judge or jury will sympathize with you if an insurance company tries rescind what they already paid. We are the ones who need it the most and the average person is on our side, not on the side of the cold heartless insurance company.


Thanks, bestadmom! Yes, I will be pursueing this with legal help. My belief is to ALWAYS appeal!
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Re: For Anybody who has Blue Cross, Blue Shield

Postby WeWillBeatMS » Fri May 06, 2011 8:31 am

Kathyj08 wrote:I got a call earlier today from American Access Care (where I am due to have my second procedure this fall) and they wanted to notify me that Blue Cross Blue Shield has pulled out from covering the procedure because it is experimental.


Kathy,

When AAC contacted you did they indicate that it was all 39 independant BCBS companies that have stopped providing the coverage for CCSVI?

I'm trying to help the group determine if it is strictly limited to Empire BCBS at this time.

Obviously, if it is limited to Empire at this time, this could snowball into other BCBS companies and other insurance providers in the near future but I just want us to be as accurate and informed as possible with today's situation.

Thanks,

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Postby Cece » Fri May 06, 2011 9:20 am

It's definitely Anthem of the "central region" too:
www.thisisms.com/ftopicp-163939.html#163939

But what does it mean that this will go into effect July 3, for the Anthem patients? Can they get treated ASAP and it will be covered?
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Postby Cece » Fri May 06, 2011 9:22 am

It's also Anthem BCBS of California:
www.anthem.com/ca/medicalpolicies/polic ... 136297.htm

Applicable to Commercial HMO members in California: When a medical policy states a procedure or treatment is investigational, PMGs should not approve or deny the request. Instead, please fax the request to Anthem Blue Cross Grievance and Appeals at fax # 818-234-2767 or 818-234-3824. For questions, call G&A at 1-800-365-0609 and ask to speak with the Investigational Review Nurse.
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Postby npost999 » Mon May 09, 2011 7:40 am

I have insurance in Illinois w/ another company that will cover the cost of the procedure (I'm scheduled for the last full week of May). However I just found out in April that my employer (state of IL) is changing the HMO plan we have from my current provider to BC/BS as part of the state plans.

So I wonder what will happen with my follow up appointments, I know I'll need 1, 3 & 6 month ultrasounds? This will be my first experience with the changing of insurance plans & so I'm curious since I'll start on one plan what will happen with my 3 & 6 month check ups? I also have not heard if I'll have co-pays for these appointments or if those are covered by the original procedure payments.

We are trying to keep our current insurance provider rather than switching, but there is only so much we can do...our employer (the state) will do whatever they please in order to make $$$ in my opinion.

NP
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Postby Cece » Mon May 09, 2011 8:11 am

The new medical policy was specifically about angioplasty w/ or w/o stenting, it didn't say anything about doppler ultrasounds. The doppler ultrasound is as much a check for thrombosis as anything else. I believe thrombosis will remain covered and that the follow-up ultrasounds will remain covered but of course don't know for sure. They're in the $300 range, aren't they? Nothing like a $10,000 venoplasty. It's uncertain too what the value of the follow-up ultrasound is although I know I've valued mine....

WeWillBeatMS, I'm under the impression that all the AAC's are not taking any BCBS as a company policy. Otherwise they could have referred out-of-state patients to Dr. Sullivan in Atlanta, who would not have been affected by the Empire BCBS policy.

That the same document popped up in Anthem of CA and Anthem of the central region's policies says to me that they share information and all 39 BCBS companies will consider adopting this new policy.
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