HELP Can someone please help with this?

Discussion in 'Fibromyalgia Main Forum' started by Adl123, Jan 3, 2007.

  1. Adl123

    Adl123 New Member

    Dear All,
    Well, I was just notified that my insurance will no longer pay for my Acupuncture. What a shock! I asked before I started, and I was told that it was covered and that there was no limit to the number of visits. Now this!

    I know I'm lucky that my insurance covered it at all,(of course, it costs me over $400.00 a month-it should) and I'm grateful. But I've been diagnosed with 17 illnesses, and I'm allergic to almost 60 medicines,(I've only tried about that number) and all of the medications for Rheumatoid Arthritis, and Fibro, among others..

    A few months ago, I was so weak, and every time I turned around I was being diagnosed with another chronic, incurable illness, so I had begun to prepare actively for my death. With the Acupuncture treatments, I was beginning to improve - I had hope again.

    I know many of you have experience with insurance companies. Mine is Blue Cross. Can anyone give me an idea of what to do? I am alreading challenging the decision, anbd am waiting from a call=back from the manager of the claims departmemnt..Will it endanger my remaining coverage if I appeal? I'm on oxygen, and I could never afford it on my early retirement teacher's salary.

    Once again I turn to you. Thank you for being there,
  2. Catseye

    Catseye Member

    My husband sold insurance for awhile and he said that it should not endanger your remaining coverage if you appeal; that's against the law. Are you a member of AARP? They have some legal resources that are included in your membership.

    If they cut acupuncture for everybody, then you're out of luck. If they only did it to you, then certainly appeal it. Look at your policy, it should have a paragraph about the appeals process. You must follow it to the letter or they will turn it down.

    good luck, I really hope you convince them to cover you

  3. Adl123

    Adl123 New Member

    Thanks a lot for the information. I'll have to get a copy of my posicy from my old school district. I retired a long time ago.

    Your advice has given me some hope.
  4. wrthster

    wrthster New Member

    Hi Terry,

    I am really sorry to here about this, I have Blue Cross of Florida and have had my share of battles with them as well. I would recommend if you have a close relationship with your regular MD, ask if he or she is willing to write a letter of "Medical Necessity" for Accupuncture treatment. I would also write a letter to the insurance company with that letter of Necessasity if you can get it. If not, write them challenging their decison, your reasons why it is essential you be allowed to continue it, and on the letter CC (carbon copy): and send a copy to your local Congressman, both Senators from your State, the Insurance Commission of your State, and the Attorney General. Let them know you specifically entered into contract with Bolue Cross because they offered this benefit and that convential medical treatment is not working for you. Send all letters certified, return receipt requested. I know this is a lot, especially when you are not feeling well. But if you catch one Senator or Congressman's eye, and they get involved it can make a big difference. Best of luck to you!
  5. dolphin67

    dolphin67 New Member

    I have worked in a medical business office trying to get insurance companies to pay benefits for over 10 years. Here are my thoughts on your problem:
    1.Your post said that that there was no limit on the number of visits, but is there a limit on the $ amount? The language they use in the policy is sometimes very specific. You may have met the maximum $ amount that they will pay for the service. If this is the case, find out if your benefit starts over with the new plan year and when does the plan year begin.
    2. Was there a policy change? If so, you should have received notice of it in writing. I know the Blue Cross up here recently went thru some major changes and things don't always run smoothly after a change. Maybe there is an error in their system edits.
    3. Don't give up after the first appeal. The squeaky wheel gets the oil. They can't hold the appeal against you. Send your medical records if necessary, but don't take no for an answer if it's a covered benefit for everyone but you. If they deem it experimental, then prove to them conventional treatment doesn't work for you and if it's suddenly experimental, why did they pay for it before? From your post, I think you have many valid points to argue with them.
    4. If you don't get satisfaction, but you still believe this to be a covered benefit, write the insurance commissioner.

    I hope this helps. Good luck to you.

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