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Blue Shield and NA
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01/26/2008 16:56
marhill 
01/26/2008 16:56
marhill 
Blue Shield and NA

Has anyone had and experience with Blue Shield coverage?

I have Blue Shield of California, a Preferred Provider Plan. Dr. Denkler isn't a preferred provider, but I expected to have the "amount allowed" to be applied to my deductible when I submitted his bill.

Instead, they said it was "non-covered", and what I have from them now is that the claim was

"denied because
it is considered to be a procedure or service that is not
appropriate to be performed in an office setting."

I may also end up with the Catch-22 that I needed pre-approval.

Any experience that anyone has had with any Blue Shield would be appreciated. (Also any issues involving follow-up physical therapy)

Thanks.

Marian

01/26/2008 18:55
SteveAbrams

not registered

01/26/2008 18:55
SteveAbrams

not registered

Re: Blue Shield and NA

Note my successful letter in appealing a denial of coverage in this forum under the topic: "HMOs and paymnet".
If you use the search engine in this website make sure you use this spelling.

Steve AbramS

04/30/2008 15:22
marhill 
04/30/2008 15:22
marhill 
Re: Blue Shield and NA

I wanted to let you know that, with help from Steve's letter when I wrote mine, that Blue Shield (California) allowed my claim for the NA.

However, there seems to be a lack of communication between the "grievance" department and the claims department, so I fully expect to have to appeal again when I get the NA done on my other hand. At least I can point out that they allowed it before.

Marian

05/09/2008 11:12
Linda B U.S.A

not registered

05/09/2008 11:12
Linda B U.S.A

not registered

Re: Blue Shield and NA

When I had my N.A. PROCEDURE IN 2004 INSURANCE DID NOT RECOGNIZE PROCEDURE..I think that has changed since Dr. Eaton presented his 5 year study to medical society.....
Have your doc write it up differently so it is not looking like plastic surgery..etc..
My medicare paid for this procedure.. Eaton at that time did not bill Blue Cross..COST WAS 12O FOR ONE HAND 80 FOR THE OTHER UNDER MEDICARE IN 2004...
Your doctor should know how to do this...
If your doctor is not under Blue Cross, etc. I think it should pay a certain percentage..

06/07/2008 22:31
moondanc 
06/07/2008 22:31
moondanc 
Re: Blue Shield and NA

I have a Blue Shield Medigap policy and Medicare. After Medicare paid their portion, Blue Shield paid theirs. Keep appealing, they *will* cover it if you provide enough documentation and force them to do it! Always ask to talk with a supervisor and keep escalating until you get results.

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