For Anybody who has Blue Cross, Blue Shield

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

Postby Shay » Tue Jun 21, 2011 12:20 am

I have Blue Cross Blue Shield (of Massachusetts). I had the CCSVI procedure done on April 6th 2011. I got a packet in the mail from my insurance saying they would not cover this procedure. I have not read the info in depth yet. I got it in the mail about a week and a half to two weeks ago. Does anyone know what date they said they would stop covering it? I am very upset about this! Agreed, if I did not have MS would this be covered? My guess is, YES. They are treating a vein problem. If an artery is blocked, they have no problem covering that. GRRRRRRRRRRRRR!!!!!!!!!!!!!!!!
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Postby newlywed4ever » Tue Jun 21, 2011 4:06 pm

Shay wrote:I have Blue Cross Blue Shield (of Massachusetts). I had the CCSVI procedure done on April 6th 2011. I got a packet in the mail from my insurance saying they would not cover this procedure. I have not read the info in depth yet. I got it in the mail about a week and a half to two weeks ago. Does anyone know what date they said they would stop covering it? I am very upset about this! Agreed, if I did not have MS would this be covered? My guess is, YES. They are treating a vein problem. If an artery is blocked, they have no problem covering that. GRRRRRRRRRRRRR!!!!!!!!!!!!!!!!


Shay, did you have your procedure done in NY? I have BC/BS of Michigan and because my procedure was done in NY, Empire BCBS does the claims. Their new "Medical Policy" was effective 4/13/11. Appeal, appeal, appeal!
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Postby zinamaria » Tue Jun 21, 2011 5:31 pm

How I hate hearing this!

I have BC/BS in New Mexico and am going to Minneapolis next week and I hope to be covered through my insurance here. It is a hope and who the hell knows!
But yes, appeal, appeal!
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Postby Shay » Tue Jun 21, 2011 10:53 pm

newlywed4ever wrote:
Shay wrote:I have Blue Cross Blue Shield (of Massachusetts). I had the CCSVI procedure done on April 6th 2011. I got a packet in the mail from my insurance saying they would not cover this procedure. I have not read the info in depth yet. I got it in the mail about a week and a half to two weeks ago. Does anyone know what date they said they would stop covering it? I am very upset about this! Agreed, if I did not have MS would this be covered? My guess is, YES. They are treating a vein problem. If an artery is blocked, they have no problem covering that. GRRRRRRRRRRRRR!!!!!!!!!!!!!!!!


Shay, did you have your procedure done in NY? I have BC/BS of Michigan and because my procedure was done in NY, Empire BCBS does the claims. Their new "Medical Policy" was effective 4/13/11. Appeal, appeal, appeal!
I had the procedure done in Minneapolis MN. I received an email today from the Dr.'s office saying that only the IVUS charge was denied. Not sure if the IVUS was covered prior to April 13. If so, I will appeal.
Last edited by Shay on Tue Jun 21, 2011 11:08 pm, edited 1 time in total.
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Postby Shay » Tue Jun 21, 2011 11:05 pm

zinamaria wrote:How I hate hearing this!

I have BC/BS in New Mexico and am going to Minneapolis next week and I hope to be covered through my insurance here. It is a hope and who the hell knows!
But yes, appeal, appeal!
I had the procedure done in Minneapolis on April 6th 2011. I have BC/BS of Massachusetts thru my work. I live in South Dakota. The Dr.'s office sent me an email today saying only the IVUS charge was denied.(Not sure if this was something that was covered before they made the changes to coverage, for the procedure, on April 13 2011). I am not sure at this point how much that means out of my pocket. If this good news doesn't hold up, I will appeal. Or if I find out that IVUS was covered prior to April 13, I will appeal. Good luck! I hope you have great improvements after the procedure.
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Postby Cece » Wed Jun 22, 2011 6:36 am

That is better news, Shay. One problem with IVUS is that it is often not reimbursed by insurance companies. The catheter is a one-time-use catheter and costs around $600 on its own. But the information gained through IVUS is valuable.

It is good too to know that BCBS is still viable in MN. :)
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Postby Shay » Thu Jun 23, 2011 4:31 pm

Cece wrote:That is better news, Shay. One problem with IVUS is that it is often not reimbursed by insurance companies. The catheter is a one-time-use catheter and costs around $600 on its own. But the information gained through IVUS is valuable.

It is good too to know that BCBS is still viable in MN. :)
Things are looking up. I do not think I will have to pay near as much as I thought out of pocket. I just received a bill and I have to pay less than $1000 out of pocket.
Waiting to see if any other bills come. When I called the billing department (at the hospital & Dr.'s office) they did not show any bills to be processed. Hopefully this is it.
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Re: For Anybody who has Blue Cross, Blue Shield

Postby tessgyp » Thu Sep 15, 2011 2:07 pm

KCMO BCBS PPO will not cover angioplasty or testing. I was told that I didn't need pre-approval (actually my Neuro's office was told that). Then I called to get it in writing. They told me they had no record of receiving docs from my Neuro's office (which were sent for pre-approval). My Neuro had them on voicemail but they still denied having said it. Then they asked that the papers be sent again. Then I received a denial from them in the mail and so did my Neuro. Hubbard foundation told me BCBS is no longer covering for the angioplasty after diagnosis based on the Buffalo Study results.
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Re: For Anybody who has Blue Cross, Blue Shield

Postby Cece » Thu Sep 15, 2011 3:34 pm

tessgyp, sorry to hear that. KCMO BCBS - what state is that? BCBS is still good in some states and not in others. For example someone from Arizona was able to use their BCBS in MN and not in NY, because the insurance goes through whatever state they're getting their procedure in, and in MN, BCBS is still paying for this procedure. If you couldn't get yours taken in CA, it might be worth checking with a CCSVI IR in another state.
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Re: For Anybody who has Blue Cross, Blue Shield

Postby Trish317 » Thu Sep 15, 2011 6:58 pm

Cece wrote:tessgyp, sorry to hear that. KCMO BCBS - what state is that? BCBS is still good in some states and not in others. For example someone from Arizona was able to use their BCBS in MN and not in NY, because the insurance goes through whatever state they're getting their procedure in, and in MN, BCBS is still paying for this procedure. If you couldn't get yours taken in CA, it might be worth checking with a CCSVI IR in another state.


I think KCMO is Kansas City, Missouri. My sister lives in Overland Park, Kansas which is about 15 miles south of Kansas City.
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Re: For Anybody who has Blue Cross, Blue Shield

Postby zinamaria » Thu Sep 15, 2011 7:49 pm

I have gotten one bill so far from the hospital in MN (angio with Dr. Cumming on June 29th this year) and BCBS is covering some of it, however not all the billing has come in. Am waiting. But so far, I have had coverage.

z
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Re: For Anybody who has Blue Cross, Blue Shield

Postby Cece » Sat Sep 17, 2011 8:13 pm

Here's a new one, I think? Anthem of Maine has the SURG.00122 policy as having gone into effect September 1st, 2011.
The policies listed below were created and might result in services that were previously covered now being considered either not medically necessary and/or investigational.)
SURG.00122 Venous Angioplasty (with or without stent placement) for the Treatment of Multiple Sclerosis

http://www.anthem.com/provider/me/f5/s1 ... r&state=me

Here is the full policy, as listed earlier in this thread:
www.empireblue.com/medicalpolicies/poli ... 136297.htm

It's a separate thread, but does anyone have any updates on Medicare? Has anyone had the procedure paid for by Medicare this summer?
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Re: For Anybody who has Blue Cross, Blue Shield

Postby Cece » Sat Sep 17, 2011 8:21 pm

http://www.unicarestateplan.com/pdf/pro ... ul2011.pdf
SURG.00122 Venous Angioplasty with or without Stent Placement for the Treatment of Multiple Sclerosis: This policy addresses venous angioplasty (with or without stent placement) as a method to improve blood flow in an abnormal venous circulation, known as chronic cerebrospinal venous insufficiency (CCSVI), found in some individuals with MS.
o Venous angioplasty (with or without stent placement) is considered investigational and not medically necessary for the treatment of multiple sclerosis

Unicare....that sounds familiar, maybe it's already been posted.
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Re: For Anybody who has Blue Cross, Blue Shield

Postby Cece » Mon Aug 06, 2012 5:20 pm

*bump*
this is an older thread

The BCBS policy was reviewed in February of this year and effective again in April of this year. Looks like minor chances in the document itself, just including new research from Dr. Siskin's group on the risks of the procedure.

http://www.empireblue.com/medicalpolici ... 136297.htm

It is an odd policy to begin with since it states that venoplasty for the treatment of MS is investigational. And it lists the ICD-9 and ICD-10 diagnosis codes for MS. But it is wrong to entangle CCSVI with MS as this document does. I had venoplasty of my bilateral jugular outflow obstructions to treat the symptoms related to central venous stenoses. I did not have venoplasty to treat MS.
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