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

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

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.