BCBS comprised of 39 independant companies

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

Would you be interested in a class action lawsuit against all insurance companies denying coverage for angioplasty for CCSVI?

Yes
16
94%
No
1
6%
 
Total votes : 17

BCBS comprised of 39 independant companies

Postby WeWillBeatMS » Thu May 05, 2011 1:06 pm

I am reading about Blue Cross Blue Shield denying angioplasty for people with MS. But BCBS is actually made up of 39 seperate companies.

Below is a link that lists all 39 of them.

http://www.bcbs.com/coverage/find/plan/

So far, I have only read about one of them denying the procedure and that is Empire Blue Cross Blue Shield which is "serving residents and businesses in the 28 eastern and southeastern counties of New York State".

As people confirm other BCBS companies that are also denying the procedure, or any other insurance company, could you please post the company name here so we can keep a track record.

This matters to ALL of us even if we don't all happen to have the insurance coverage that is being denied. Eventually we should start thinking about getting together and filing a class action lawsuit.

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Postby Kathyj08 » Thu May 05, 2011 4:01 pm

I have Anthem which is Indiana's version of BC/BS. I've not found out anything yet from them but will post when I do have news. I was going to see Dr. S. the first week in August but now have research to do.
I had the us and consult with him in March and all that was covered but I guess the trouble didn't start until the following month with them pulling out.
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Postby WeWillBeatMS » Fri May 06, 2011 8:58 am

I'm still trying to determine if this whole BCBS denial is actually just limited to 1 of the 39 BCBS companies or not. The one being Empire Blue Cross Blue Shield which we do have confirmation on in black and white straight from their website.

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

But that's it as far as I can tell. Hopefully Dr Sclafani or someone can add some clarity as to where the other 38 BCBS companies stand on this.

Either way, the likelihood of other insurance companies following in Empire's footsteps are good and I think we need to start thinking about finding an attorney or law firm that would like to take on a class action lawsuit on our behalf. As of last count there are 8 YES votes and 1 NO vote on the poll question of whether you would be interested in participating in a class action lawsuit against any and all insurance companies denying treatment of CCSVI. Please vote.

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Postby Cece » Fri May 06, 2011 9:10 am

I did a google search on key words like medical policy and venous angioplasty and multiple sclerosis to see what turned up. This might be something?
SURG.00122 -- Venous Angioplasty with or without Stent Placement for the Treatment of Multiple Sclerosis

This is a new medical policy which considers venous angioplasty (with or without stent placement) investigational and not medically necessary for the treatment of multiple sclerosis.

www.bluecrossca.org/provider/noapplicat ... 154296.pdf

It's a network update for the central region by Anthem. April 2011.
Medical policy update
The following Anthem Blue Cross and Blue Shield (Anthem) medical policies were reviewed on February 17, 2011 for Indiana, Kentucky, Missouri, Ohio and Wisconsin. These policies will be implemented on July 3, 2011.
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Postby WeWillBeatMS » Sat May 07, 2011 7:06 am

Thanks for finding that Cece. I think you are our resident Google master. So far it looks like we have a total of 6 of the 39 Blue Cross and Blue Shield companies that confirm in black and white that they will not pay for angioplasty as a method for treating CCSVI. The unscrupulous BCBS "Goliath" companies that are basically saying "we don't think you patients have the guts to stand up to us" are:

1) in New York - Empire Blue Cross and Blue Shield
2) in Indiana - Anthem Blue Cross and Blue Shield
3) in Kentucky - Anthem Blue Cross and Blue Shield
4) in Missouri - Anthem Blue Cross and Blue Shield
5) in Ohio - Anthem Blue Cross and Blue Shield
6) in Wisconsin - Anthem Blue Cross and Blue Shield

Get your slings ready Davids.

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Postby Cece » Sat May 07, 2011 7:43 am

and #7) Anthem Blue Cross Blue Shield of California

www.anthem.com/ca/medicalpolicies/polic ... 136297.htm

The other problem is that any BCBS patient from elsewhere in the country that wants to be treated in NY (by Dr. Siskin, Dr. Sclafani, Dr. Sperling, etc.), their insurance even if it's BCBS of whatever state has to go through Blue Cross Blue Shield Empire to get treated in NY. So we have people right now who are eligible for treatment elsewhere but not in NY.
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Postby dk » Sat May 07, 2011 12:09 pm

I have Horizon BC/BS and spoke to someone there yesterday. She said the same thing Cece is saying. Even though they are separate legal entities, the BC/BS where the doctor is located is the one that handles the billing. So unless Dr. Sclafani plans to move, those of us with BC/BS will have to pay out of pocket to be treated by the best of the best. And that means follow up care and repeat procedures if needed. This really stinks.
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Postby fogdweller » Sat May 07, 2011 12:34 pm

I have Anthem Blue Cross of California. They pre-approved my follow-up treatment (I already had the original angioplasty, paid out of pocket, and after considerable work on my part they paid me back a few hundred dollars).

When I was about to leave home for an 11 hour drive to San Diego for treatment, Jared from the Dr.'s office called and said Anthem had canceled their pre-approval and were trying to make the Dr. pay them back for the procedures they had already reimbursded!!!

It would be nice to be able to boycott Anthem, but for those of us with pre-existing conditions (all of us) we are kinda stuck.
Last edited by fogdweller on Sat May 07, 2011 1:34 pm, edited 1 time in total.
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Postby Cece » Sat May 07, 2011 1:00 pm

fogdweller, what you have gone through. Hope you're handling it ok. I can't imagine the frustration.

I checked BCBS of MN, it looks good, no policy on CCSVI, here is where upcoming policies will be listed if BCBS of MN develops such a policy:
http://notes.bluecrossmn.com/web/medpol ... g?OpenView
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Postby fogdweller » Sat May 07, 2011 1:12 pm

Cece wrote:fogdweller, what you have gone through. Hope you're handling it ok. I can't imagine the frustration.


I am still going down Friday for a Zamboni protocol ultra-sound. Finally. My first post-procedure look-see at my jugulars to see what we shall see. Out of my own pocket, unfortuantely. If it looks bad, I will appeal post-hoc to say it was indeed necessary since there is a problem. Don't know if that will work.

As far as frustration, I really can't complain. My CCSVI journey has been difficult, and so far has not resulted in any improvement, if anything some slight acceleration in progression. However, my MS has been mercifully slow over my life. It is over 35 years since diagnosis, and I can still walk 2 or 3 blocks, am not in a chair and only need to use a cane occationally. Neuropathic pain in the feet and legs is beginning to be a problem, as is memory, especially names, but overall I can't really complain.
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Postby newlywed4ever » Sat May 07, 2011 8:47 pm

I got a call from Frank Higgins (AAC) 5/4/11 telling me that BCBS will not be paying for my scheduled followup in August with Dr Makris due to this new policy. My policy is BCBS of Michigan; Dr Makris is in IL....
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