Any luick with insurance companies?

Discussion in 'Fibromyalgia Main Forum' started by katdancer, Apr 15, 2006.

  1. katdancer

    katdancer New Member

    Hi! As I stated a couple of posts back I'm new to this board - hopefully you have room for a newbie.

    I was just wondering if any one else has had to struggle with insurance companies about "durable goods" such as a bed or hot tub? We have recently purchased and adjustable bed so that I can get out of the recliner and sleep like a real person and also a hot tub for exercise and relaxation and of course BC/BS is not willing to cover any part of it.

    We have decided to appeal is but was just wondering if anyone else has had any experience and could offer any suggestions.

    Thank you!!!!!
  2. kbak

    kbak Member

    Katdancer,
    You might have a better chance of getting covered if your doc will Dx that product. We use to have BC/BS, and if you can prove need with a docs prescription, many times they'll pay.

    Without a specific Dx, it just won't happen.

    Welcome aboard. Lots of good info here.

    K.
  3. kjfms

    kjfms Member

    ...you physician has to make a medical necessity diagnosis for durable products.

    Speak with your physician and the Billing/Coding person in the office to make sure this is done correctly. Make sure it is documented in your medical record as well not just on an Rx. Good luck to you.

    Thanks,

    Karen
  4. katdancer

    katdancer New Member

    BTW, if the board starts moving fast and your post starts dropping back, "bump" it to keep it on the 1st page. Just click "reply" and put "bump" in the title and body.


    thank you for the help - it might take me a bit to catch on
  5. katdancer

    katdancer New Member

    Katdancer,
    You might have a better chance of getting covered if your doc will Dx that product. We use to have BC/BS, and if you can prove need with a docs prescription, many times they'll pay.

    Without a specific Dx, it just won't happen.

    Welcome aboard. Lots of good info here.

    K.


    thank you K we have done that - doctors letters, Dx all that but have been told "it" looks like it's going to be rejected - guess time will tell. Our insurance says that after an appeal we can get an attorney but fear it's not for great big bucks so they might not be too interested but for us to get back any portion, much less close to 80% would be real nice!
  6. katdancer

    katdancer New Member

    ...you physician has to make a medical necessity diagnosis for durable products.

    Speak with your physician and the Billing/Coding person in the office to make sure this is done correctly. Make sure it is documented in your medical record as well not just on an Rx. Good luck to you.

    Thanks,

    Karen



    Guess I could have been a whole lot clearer - it's been noted (well noted) Dx all in my records, have prescriptions, actually for several years just could not afford it until recently. BC/BS said we should have gotten approval from them - we called and were told they might cover some of it but not likely but go ahead and submit it so of course we did. The problem was - us being too gullible - ran into several reps who said "oh it looks like it's gone up for approval and there are only certain people who can cover that amount for the check to be cleared". We made the mistake of thinking they knew what they were talking about, got our hopes up then ran into another CSR who said "oh H___ no it aint gonna happen" so here we go.... off fighting again........ I certainly understand if they don't cover even 80% but gosh just seems you pay and pay into insurance, have all the proper documentation and it's still fight, fight, fight for ever nickel and dime. It really has been amazing the difference a decent bed has made not to mention the hot tub to sit and exercise in but of course an insurance company is not concerned with my little life and if I am living it a tab bit easier huh??

    Thanks everyone for responding - sure appreciate it!
  7. pepper

    pepper New Member

    My dr. prescribed a hot tub but, even though we have a pretty good insurance company, they refused to cover it. I tried again for a far infrared sauna - but no go!

    Good luck! I hope your insurance company is better than ours!

    Pepper
  8. ripebear

    ripebear New Member

    have bc/bs also. dr prescibed walker with seat. when i bought it, i saw the little shopping basket. so the clerk added that to the script.
    got a letter from the dr, at first bc/bs only approved the basket.
    i called and asked what the h--- was i supposed to attach it to. i mean, was i supposed to walk carrying the basket?
    put claim in again, and walker was approved, but not seat.
    apparently, a basket is covered, but the seat i need to rest isn't.
    lol
    good luck. sometimes i think it depends on the day the claims person is having. the companies fgure you'll give up eventually and they'll save money.
  9. katdancer

    katdancer New Member

    bump (hope I did this right!)
  10. katdancer

    katdancer New Member

    good luck. sometimes i think it depends on the day the claims person is having. the companies fgure you'll give up eventually and they'll save money.


    Well, this time we are gonna hang in there figure the only thing we have to lose is time.... Gesh - a basket but no seat - how crazy! Although sometimes I feel like ya could just pour me in a basket LOL!!! If all else fails we can use our medical spending account at my husbands work to cover part but would just be nice if BC/BS would cover some of it. They would cover a tub sort of thing - more like a barrel and heavens knosw how one would even get into it much less out and zero room for stretching. If anyone cares I'll post and let ya know the outcome - might be a year or so LOL!!!

    Thanks again for the support and responses.
    Sunny