I got the official zero coverage notice from BCBS today, so I'm out the whole $710 for my Igenex tests.
Has anyone w/ this insurance fought an appeal successfully? I'm not sure it's worth my limited time and very limited energy to try.
I'm so fed up and broke!!!
monkeyshines
Posted by lou (Member # 81) on :
Sending you a pm
Posted by Lymetoo (Member # 743) on :
NO, but Aetna did.
Posted by serendipity (Member # 8474) on :
I had BCBS of MA at the time my Igenex tests were done.
When I filed my initial claim explaining that I had numerous expensive and even invasive tests over the years which yielded nothing. I wrote that I believed this test would save them money on diagnostic procedures. It did, I had no further testing other than routine bloodwork and a SPECT scan.
Additionally, I had a letter from an in-network doctor stating the test was medically necssary. And they paid in full.
Posted by stella marie (Member # 7216) on :
BCBS PPO in GA did not pay mine either, it was done in feb of this year
[ 07. December 2006, 11:19 AM: Message edited by: stella marie ]
Posted by lymex5&counting (Member # 7202) on :
Like Cave said it depends alot on your plan as far as what coverage you get.
Is it a PPO?
I am surprised you didn't get 80% coverage if it is a PPO, since IGeneX is considered out of network.
All 6 of us apply for PPO waivers for IGeneX. So far both my IL and AL policies have paid 100% for all our IGeneX testing.
MDL - Medical Diagnostic Laboratories is in
network for BCBS. Maybe you can run a panel with
them next time testing rolls around. It should
automatically be covered at 100%. The 2 of us
that don't have CDC positive western blots from
IGeneX have positive urine PCR's from MDL.
Lyme x 9
Posted by Lioness (Member # 10655) on :
I have BCBS PPO and didn't even think to submit for reimbursement. My LLMD said BCBS would not cover it so I paid out of pocket.
Mine was done February of this year too. I wonder if it can still be submitted???
Posted by monkeyshines (Member # 6406) on :
UPDATE.
I need to retract my premature irritation....or at least withold it til the final word is in.
Lou asked me via pm what the reason was for denying the claim (thanks, Lou). When I looked more closely, it said something about the provider should have submitted it to the local BCBS, and that they (my BCBS, out of Maryland) would send it along 'as a courtesy.'
So I guess that means I haven't heard the final word yet.
I am in a PPO, btw.
Lioness, I'd give it a try if I were you, you never know.
Thanks everyone for feedback!
monkeyshines
Posted by sweet pea (Member # 6495) on :
The process was very bureaucratic and confusing, but BCBS reimbursed most of the cost of an out-of-state (= out-of-network) parasite test for me.
The first time I submitted a claim, they sent it back because my ID# was one digit off. They knew who I was and couldn't just change it themselves. Nice way to treat sick people, huh?
Posted by Lioness (Member # 10655) on :
Thanks monkeyshines. I am seeing a new LLMD next month and I am sure I will be tested for coinfections (I wasn't when I had my first Lyme test).
I will make sure to submit everything for now on!
The worst they can say is "no," right?
Posted by Nebula2005 (Member # 8244) on :
Lioness--
I submitted my Igenex claim with the form on the website for medical self-pay claims. Also mailed along copies of the paperwork Igenex sent me. You could probably still do this.
My Florida BCBS PPO paid $127.20 of the $553 total--better than nothing, I guess. they base it on what they would pay an in-network lab, which for the same tests adds up to $212, minus what would be my resposibility, $84.80.
I love unsurance company math.
Posted by Lymetoo (Member # 743) on :
It's definitely worth a try, monkey!
Posted by trails (Member # 1620) on :
my BCBS coverage from NM paid about 200 bucks out of $1,000 worth of testing in 2005. it is worth resubmitting it.
Posted by Dianne (Member # 9450) on :
I'm on SSD, covered by Medicare, and I only had to pay $34 for the babesia panel I had done by IGeneX in July. A Lyme panel was supposed to be done at the time too but there was some misunderstanding, by someone at my doctor's office, and it didn't get done.
It took me months to realize the Lyme panel hadn't been done so I'm waiting now for the results from that. Hopefully, I won't have to pay any more than I did before, after Medicare pays their part. I'm very ANXIOUSLY awaiting these results because I'm fed up with this fibro diagnosis.
Antibiotics make me feel better, when I've been given them for other reasons, like sinus infections, so it's pretty obvious to me that I need some long-term antibiotic treatment. I just hope I can find one that doesn't give me adverse reactions, like the Cipro I was taking this week for sinusitis which caused blurred vision.
Good luck with your insurance claims...
Posted by on :
![[Frown]](frown.gif)