lauriw:

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Hi everyone,
Some of you know that I have been denied for RT for my DD by BCBS. I have appealed and am ready to take this all the way with BCBS. I think this might be the time to start compiling a list of all of the insurance companies, states, etc, as a database for these fights with insurance companies. Even though I know that BCBS has paid for this therapy in many states, it is very useful to go to them and state with accuracy all of the policies that have paid for the RT and in such help prove that this is MEDICALLY NECESSARY. With that said, I want to start this thread so that everyone can look in one place and see what has happened in the US over the past several years. So I propose that anyone that has been approved or not, start sharing this information! We need to help each other.
LauriW

LauriW

Flojo (Flora) is in the process of appealing with Medicare...let us hope she is successful, because I think Medicare paying is the "key"...usually secondary insurances only pay after Medicare does... this is so important to all of us. I hope everyone gets involved here !!!

Edited 03/02/11 19:05

Speaking as someone who has been on the provider side, you just need to be prepared to fight and not give in. It also helps if you have a medical professional who is willing to make phone calls, write letters. If you're dealing with a claims rep who isn't familiar with the disease, someone has to give them convincing information for why this is medically necessary. It's hard, but you can change the 'no' to a 'yes'. Specific functional information is very important to medicare. Be prepared to justify your need in terms of how your activities of daily living are effected.

Here are my codes from 2009

Clinical treatment plan: 77263
Field verification simulation: 77280
Simulation complex: 77290
TX device complex: 77334
Weekly mgmt.: 77427
Complex Rad TX: 77413 X 5 days
Basic Dose Calc: 77300
Continuing Med Physics: 77336


Lori

what year was your treatment in?
lauriW