Appt. with Dake in Dec. but need help with insurance stuff

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Appt. with Dake in Dec. but need help with insurance stuff

Postby prof8 » Tue Nov 10, 2009 8:47 pm

Hi all

I desperately need advice. I have an appointment with Dr. Dake in early December. I actually sent all of my records to Alex and the doctor in early August! I made the appointment in Aug., did not hear from them for 3 months and so I assumed everything was okay. I called 2 weeks ago to confirm my appointment in Dec. Alex told she is still having issues with my insurance which came as a shock to me. I have two insurance plans (primary and secondary) and they are both BCBS. I know for sure that Stanford is listed as in-network on my primary plan because I checked that myself.

She said she is getting mixed answers about whether it's covered. Once they said yes, now they say the radiology is not covered because it is not part of the Stanford facility??? And Alex said she is being bounced from dept. to dept. Alex told me she started dealing with the insurance on Oct. 15. To be honest I am very confused and frustrated especially since they have had 4+ months to get approval and time is running out (I am supposed to go in 4 weeks).

Did anyone's approval take this long? Do you think there is something I could do to resolve this? (like call the insurance company myself)? I talked to Alex on Monday and she said she was working on my case and would call me at the end of the day but I have not heard from her.

I'm just wondering what other people's experiences were. I'm really panicking because I thought I was going for sure and now there seem to be no answers and time is running out.

Thanks for you help so much!!
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Postby CureIous » Tue Nov 10, 2009 9:53 pm

Hi, I am in the BCBS network from LA area, they are my network but not my insurance, i.e. "who actually cuts the check".
Yeah, that makes a lot of sense, imagine what all of us in the uni0n went through lol. However, everything that happens, goes thru BCBS first, a real pain since it adds another layer of complexity to the issue. This much I know for sure, my radiology bill so far is 300 bucks, that's it. The other 12k or whatever it was, was either paid (12,895 I just looked), or rejected as a contractual adjustment. Stanford is definitely in the network, my radiology bill came from Stanford. This was one of the FIRST questions I asked, since radiology can be a bit dicey sometimes, they can be IN the hospital but not a part thereof. Then you get a bill from Joe Blow radiology and it's ???.

All my radiology stuff came through on Stanford billing, so not sure why they are saying it's separate.

This much I know, is that the BCBS "turnaround" for approvals was very fast, in some cases 24 hours. Also, Alex may need to do the approval in December, i.e. the month of the procedure, just to keep things flowing well. IOW getting approval 1 month early for a necessary procedure throws a wrench in the works, my procedure was August 3rd so I'm with ya, same exact happened to me, came down to the wire but it all worked out just fine. I know that pins and needles feeling since there is so much planning going into your trip, when you are trying to concern yourself with getting mentally prepared and instead it's all this claptrap throwing a wrench in the works. It's ONLY November 10th, there is plenty of time in between now and then, and if anyone can get the ducks in a row it's Alex, and I don't say that lightly.

Deep breath andddddd exhale....

Keep us appraised, it will be interesting to see how BCBS does now that these procedures are becoming more well known. Hang in there. You can always pm me if you have any specifics I can help with, which aint much but feel free.

mark.
RRMS Dx'd 2007, first episode 2004. Bilateral stent placement, 3 on left, 1 stent on right, at Stanford August 2009. Watch my operation video: http://www.youtube.com/watch?v=cwc6QlLVtko, Virtually symptom free since, no relap
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Postby radeck » Tue Nov 10, 2009 9:59 pm

Prof8, my guess is that Alex didn't work on it earlier because most insurances didn't refuse to authorize the testing, so she may have just assumed that everything would go well in your case.

I was one of the few (I believe there was one other person after me) whose insurance refused to pre-authorize the scans. Since they are a covered service, insurance still had to pay 50% and financial assistance paid the remainder.
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Postby CRHInv » Wed Nov 11, 2009 12:12 am

I just went thru that too. Darcy and Alex got it all figured out though. I was so worried, but they kept after it and got it done. They will take cf you.
dx 4/09 * Stanford appointment 11/09/09 * One stent left, low jugular 11/10/09!<br />One year from treatment, I have my life back.  Placebo schmebo.
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Postby MaggieMae » Wed Nov 11, 2009 6:14 am

I'm having problems also. Before we schedule our appointment for the testing and procedure at Stanford, I asked to find out if our insurance would cover it. My husband has BCBS (primary) through my work and his Medicare is secondary. My concern is what would our insurance cover since he already had some of these tests done at our local hospital in August (we never should have tried that approach). We received a letter saying that the NIO okayed the MRI, but not the MRA/MRV. Alex was going to have Dr. Dake call the insurance last week. We have not heard anything. I hate to make a committment and find out that we are not covered. Is that what most are doing - just going for it and not worrying about coverage?
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Postby Sharon » Wed Nov 11, 2009 7:17 am

Hi All!

My suggestion would be is to let Alex and Darcy work their magic. I know everyone wants to get things all lined up two months in advance, but insurance just does not work that way. It is not unsual for an insurance company to not pre-approve more than 45 days out. I think Dake's staff has done a remarkable job this summer --- remember this all started with Jeff in May and then we all started ringing their phones. Dake had no idea he would get such a response (that is why he added Alex and Darcy---poor Angela could not keep up).

Hang in there -- if need be, Dr. D. will talk to the insurance company himself. Oh, and I would advise that you not call the insurance company -- keep out of the process unless Darcy or Alex want you to intervene.

Sharon
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Postby Ruthless67 » Wed Nov 11, 2009 8:10 am

I too have BCBS of Calif. I haven't had the procedure yet at Stanford, but in the past with my husband's knee surgery at an in Net-work hospital, the X-ray EOB came back to me saying they were not an in-network provider. It only took one phone call to the insurance to tell them that "we had no part in the choice of x-ray technician" and they resubmitted and it was covered. It was so long ago I don't remember what we paid, but it wasn't much or I'd remeber that!, lol.
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Postby bluesky63 » Wed Nov 11, 2009 10:54 am

I can relate to feeling anxious about having insurance cover your costs! It creates so much stress. Right now I am in the middle of having one insurance company for November and December, and then switching to a new one for January.

It's stressful for the staff too. They can only get the approvals within a short time of the procedure, so their hands are tied a little bit. If Alex had started in August it might have been too early. They definitely want everything to go well for you, and they're on your side! It's so hard to wait, but remember that the staff has dealt with so many different insurance companies and has been able to do all sorts of things to help people.

BCBS is very confusing. Good luck getting it all sorted out. Then you can concentrate on the actual procedure . . . :-)
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Postby MaggieMae » Wed Nov 11, 2009 11:17 am

MaggieMae wrote: Is that what most are doing - just going for it and not worrying about coverage?


Just asking again - should we make the appointment without knowing what our insurance will cover and hope for the best? When I had talked to Alex last month she said we were at step three - getting insurance approval. As I understood her, without approval we would have to pay for the tests. I thought everyone worked out the insurance before they scheduled. Maybe we are going about this all wrong and that is why it is taking months to get scheduled.
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Postby Loobie » Wed Nov 11, 2009 11:26 am

THis is my opinion, and treat it as such, but I wouldn't call your insurance company but rather let Alex and Darcy handle it. They know the codes and all that and if we start fumbling around, the ins. co. may try to get more out of you than they would Alex. They can be tricky. I would just keep asking her, but if she says she's having problems she probably is, she is a very hard worker.
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Postby Sharon » Wed Nov 11, 2009 11:33 am

MaggieMae
Just asking again - should we make the appointment without knowing what our insurance will cover and hope for the best?


Yes, make the appointment - you can always cancel. It is easier to cancel then to get a time for the testing ----Dake understands this.
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Postby prof8 » Wed Nov 11, 2009 1:40 pm

Thanks all for the very useful information and support. I will try to be patient. It's hard because I was mentally psyching myself up to go have the surgery and now all the balls are in the air again. I'm bad with uncertainty and change and like to plan way in advance (funny right, because MS isn't the best disease for this!). I think once I got a bill for an out of network test inside a BCBS covered facility. I tried to tell them I didn't have a choice but I ended up having to pay something. But I will hope that Alex figures this all out. I've already got the plane tickets--hopefully that wasn't a stupid move. But she did make the appointment long before she started looking into insurance.
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Postby Sharon » Wed Nov 11, 2009 1:48 pm

prof8

Remember the financial aid at Stanford. Ask Alex to give you the forms. Stanford is really trying to work with everyone.

Sharon
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