This Is MS Multiple Sclerosis Community: Knowledge & Support

They may be telling me that because I have not had a ms diagnosis.

Here's what AAC has done to me...

First, please note that I think the world of Dr Sclafani and do not wish to hurt him and what he is doing. However, I am very frustrated with AAC billing. I had my 2nd procedure 1/28/11 by Dr Sclafani (my 1st procedure was with Dr Siskin and BC/BS covered 100%). Prior to my appt., Deb Helmer of AAC billing told me that she tried to get pre-auth from BC/BS - which BC/BS denies ever getting a call from AAC and indicated the pre-auth was unnecessary. I did get the procedure & diagnosis codes from Ms Helmer and called BC/BS myself. I was told that all the codes were covered and Dr Sclafani is an approved provider. When I told Deb Helmer this, she indicated verbally that she had "a bad feeling" about my insurance covering this and I would be required to self-pay. I kept my appt. with AAC feeling that I had covered all bases. At AAC, I again indicated to Nancy (office manager) that I was told by BC/BS that the procedure was covered and that it was probably in AAC's best interest financially to bill the insurance company. I also indicated to Nancy that I would guarantee payment if the procedure was denied. Nancy told me that it came from billing that I would have to self-pay the discounted price which I then put on my credit card (yikes). I still felt confident that I would be reimbursed in a timely manner. I rec'd an itemized statement from AAC to submit to BC/BS. The itemized statement showed the procedure billed at $10,000. I submitted this and BC/BS processed a check on 4/5/11 - however, since they only cover a percentage of the cost, the reimbursement was only a little over $5300. BC/BS sent this check to AAC (by contract, they must do this and then the provider reimburses me). Numerous phone calls were made to AAC with different excuses as to why they hadn't reimbursed me. As of 5/2/11, AAC told me they had to send the check back to BC/BS due to a new Medical Policy from Empire BC/BS that CCSVI was not covered. The AAC contract manager at AAC claims that this is retroactive and all $$ rec'd prior to 4/12/11 will have to be paid back to BC/BS (I find this hard to believe). I have a copy of the Medical Policy and it states: "Venous angioplasty is considered investigational and not medically necessary for the treatment of multiple sclerosis." Dr Sclafani has always indicated that he is NOT treating MS, he is treating CCSVI.

This whole mess has been financially and emotionally taxing. Anyone else with similar problems from AAC billing? My belief is that Ms Helmer made a very costly mistake and I am the one who ultimately loses.

The good news is that the BC/BS rep told me that the outcome will be favorable to me and I will be reimbursed for the $$ I paid - I interpret this as the whole $10,000 - keeping my fingers crossed!

I bet if Dr. S knows about this, he'll have AAC reimburse you right away, then heads will roll. With him, it's all about being truthful.

I had two procedures with the good doc before AAC, and I needed a precert. I was told by AAC that I didn't need one for my April treatment. I had a bad feeling that I'd get caught with a huge bill so I requested everything in writing, which I still have. The claims were submitted but insurance hasn't settled them all, just one which they denied as a double charge.

Legally, if a doctor or practice accepts your insurance, by contract you are only responsible for your copayment once your deductible is met. You will get your money back and AAC is on the hook. But what a waste of time and effort on your part to do the job of someone who is clearly incompetent.