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Bcbs Denied My Stem Cell


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6 replies to this topic

#1 Gidget

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Posted 19 March 2007 - 09:42 AM

BCBS denied my stem cell saying it was "investigational". I have exhausted all my appeals with the Company. I have been in touch with my state's Atty. General to see if their office will provide some support. They are reviewing the documentation. I have also been in touch with my state's health advocate but have not yet heard anything back. Has anyone had a similar experience or been in a similar situation with Blue Cross? Does anyone know of an instance where Blue Cross covered the stem cell for scleroderma? Does the ISN have a legal advocate? Thanks Gidget

#2 Heidi

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Posted 19 March 2007 - 09:54 AM

Hi Gidget,

I am so sorry that BCBS turned down your approval for stem cell. How frustrating! I can only imagine how aggravated you must be right now. I don't have any words of advice for you....just wanted you to know that I feel for you. I certainly hope that one of your other avenues will pan out (the attorney general or the state's health advocate). I will definitely keep you in my thoughts....please let us know what you hear.

Warm wishes,
Heidi

#3 Shelley Ensz

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Posted 19 March 2007 - 11:14 AM

Hi Gidget,

I'm sorry that your appeals for the stem cell transplant haven't worked so far. Usually the medical center conducting the stem cell transplant would have a resource person who would help you with this. Have you been working with them on this? What do they advise?

I have heard that sometimes people have hired a lawyer and go to court to get the procedure approved by their insurance company. The legal cost can run into thousands and thousands of dollars, however it is less than paying for the procedure out of pocket. But because of this, very often the most likely candidate for a stem cell transplant is a very wealthy person with great insurance, who also happens to have severe rapid onset diffuse scleroderma.

We do have an ISN Legal Advisory council, however, that is for our nonprofit organization as a whole, and not for personal legal assistance, since providing legal assistance is not part of our authorized mission. If you cannot afford a lawyer, you might also try contacting your local Legal Aid society, to see if they can offer any help. It may require sound medical and legal advice to acquire (or try to acquire) coverage.
Warm Hugs,

Shelley Ensz
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International Scleroderma Network (ISN)
Hotline and Donations: 1-800-564-7099

The most important thing in the world to know about scleroderma is sclero.org.

#4 janey

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Posted 19 March 2007 - 11:21 AM

Gidget,
BCBS decline to pay for a CRP bloodtest. They said it too was investigational and hadn't been proven to be a true marker for heart problems. When I told them my doctor was using it as a measurement for inflammation the response - "Oh - well we don't know anything about that either." DENIED PAYMENT. It wasn't much ($49) so I paid it because it wasn't worth my time to argue with them. However - in the event of a stem cell transplant, every minute of your time is worth the fight!

I hope you get some help or at least some good advice through your Attorney General. Let us know what you find out.

Big Hugs,
Janey Willis
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#5 LisaBulman

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Posted 19 March 2007 - 12:57 PM

Hi Gidget,
I would keep fighting if I were you. I know it is exhausting but it can be worth it. My insurance company said they would pay for my daughters surgery, but now only paid less than half of the surgeon's bill because they said he is out of network. I am off to battle with them. Can you dr appeal on your behalf? Did you send in medical documentation? I sent in printed material to get them to pay for the visit the first time we went to the specialist out of state.

Don't give up!!!

Hugs,
Lisa
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#6 emmie

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Posted 19 March 2007 - 06:13 PM

Gidget,

I'm so sorry to hear this. BCBS is the company that originally paid for 5 consecutive IVIg infusions with no question and then denied 2 given in 2 consecutive months. They eventually paid but said they would not pay for anymore saying it was a mistake they had paid for any in the first place.

We since have a new insurance carrier due to a job change. The doctors I had been seeing for over 2 are not covered by this company and we have a PPO. They are at a top rated university hospital in a major metropolitan area but this hospital/clinic does not accept this insurance. So I have to start all over.

I, like you I am sure, am tired of so much of our health care being dictated by insurance companies. Then I calm down and think, be grateful that you have insurance.

I will think positive thoughts that something will break your way and things will move quickly for you.

xoxo emmie

#7 Heidi

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Posted 20 March 2007 - 02:17 AM

Hi Emmie,

I have been thinking about you. How are you doing? How is finding all new doctors going? And, any progress on getting approval for my IVIg treatments?

Warm wishes,
Heidi