Insurance Hassles

Discussion in 'Fibromyalgia Main Forum' started by EllenComstock, Sep 6, 2002.

  1. EllenComstock

    EllenComstock New Member

    Hi, just wondered how many of you have experienced this situation I am with my insurance right now. My insurance in general is good (however I still have to sometimes fight with them to pay). I am currently seeing a fibromyalgia specialist (an hour one way to get to his office from work and 45 minutes from home). The doctor's office said that if I see the doctor, I can't have my massage therapy that day. However, if I were having a test, I can do that the same day as seeing the doctor. It's only the therapy that I can't do any other procedure with on the same day. So as a result, on the weeks I am scheduled to see the doctor, I have to go an extra day so I can have therapy twice a week or only have therapy once that week. Other doctor's offices I have gone to I could see the doctor and have any other procedure done and the insurance would cover it. The fibro specialist office said their office was different than other doctor's because they offer therapy and that's how the insurance is set up.

    I called Blue Cross and they claimed it was the way the doctor's office was billing it is the reason they won't cover both procedures. They said that the doctor's office can only bill them once a year for a doctor's visit, but I certainly see him more than once a year. So obviously they must be billing it as something else like therapy so as long as they are doing that, then why not schedule me for therapy on the same day?

    I'd like to know how exactly these "rules" are set up. They certainly aren't helping the patient any. We are sick people and some days it's real effort to drive to the doctor's office especially after having worked all day.

    Thanks for letting me vent. It will be interesting to hear other people's stories.

    Ellen Comstock
  2. EllenComstock

    EllenComstock New Member

    Hi, just wondered how many of you have experienced this situation I am with my insurance right now. My insurance in general is good (however I still have to sometimes fight with them to pay). I am currently seeing a fibromyalgia specialist (an hour one way to get to his office from work and 45 minutes from home). The doctor's office said that if I see the doctor, I can't have my massage therapy that day. However, if I were having a test, I can do that the same day as seeing the doctor. It's only the therapy that I can't do any other procedure with on the same day. So as a result, on the weeks I am scheduled to see the doctor, I have to go an extra day so I can have therapy twice a week or only have therapy once that week. Other doctor's offices I have gone to I could see the doctor and have any other procedure done and the insurance would cover it. The fibro specialist office said their office was different than other doctor's because they offer therapy and that's how the insurance is set up.

    I called Blue Cross and they claimed it was the way the doctor's office was billing it is the reason they won't cover both procedures. They said that the doctor's office can only bill them once a year for a doctor's visit, but I certainly see him more than once a year. So obviously they must be billing it as something else like therapy so as long as they are doing that, then why not schedule me for therapy on the same day?

    I'd like to know how exactly these "rules" are set up. They certainly aren't helping the patient any. We are sick people and some days it's real effort to drive to the doctor's office especially after having worked all day.

    Thanks for letting me vent. It will be interesting to hear other people's stories.

    Ellen Comstock
  3. Shirl

    Shirl New Member

    Just stopped to bump this up for you, as I can't help. Someone here should know a way around this dilemma you seem to be in.

    Shalom, Shirl