Meds, Mind, Body & Benefits > Questions About Treatment & Side Effects

BCBS Level II Appeal?


ya know itz not bad enough that ya gotta battle the virus; but ya gota battle the dr, lab company, drug company.......& the insurance company! <iknow, i lucky to have it>

ill start w/ the question and go to the story this time:

anyone have a Level II appeal w/ Blue Cross & Blue Shield?

diagnosed 7/06 and received a GenoSure test. BCBS denied the payment as 'experimental' After a Level I appeal they paid for it. went into viro failure 11/06 and doc ordered another one to pick out the new regime. now their denying this for 'instrumental'. these things arnt cheap......$700.

i filled out the level I form w/ a letter from the doc stating i was in viro failure and citing the health & human services guideline for the treatment of HIV suggestion resistance testing while on the failing regime updated 10/2006.

so the fucking idiots deny the appeal citing: "a clinical and contractual rationale that the test was instrumental". The service, procedure or supply must be provided for the diagnosis, treatment, cure, or relief of a health condition, illness, injury.

im mean iv got blond hair but their criticizing their own decision. if the H&HSD sez do the test, the doc sez do the test, then do the test!

so now im @ level II, which requires a meeting in durham nc. bet ur ass ill b there. i might not win, but theyll b a buncha insurance beuarcrats that r gonna get an ear full.  >:(

anyone wanna do a road trip and do a protest hit me up:) seriously though anybody had to do one of these before let me know!


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