Insurance Question for FFC'ers

Discussion in 'Fibromyalgia Main Forum' started by intrigue, Dec 12, 2005.

  1. intrigue

    intrigue New Member

    I have Blue Cross and Blue Shield of Texas, which means my Quest lab work is covered "in-network" and my FFC visits and treatments are "out-of-network." (Out of network only pays 60% or so of covered treatments)

    Most of the claims for my lab work was paid pretty quickly. However, insurance denied the claim on two of the tests. I called the insurance company and they said they require something from the doctor stating what this test was for and why it was medically necessary. In the meantime, I have a $480 bill from Quest (for two tests)

    Has anybody else had this sort of problem?

    Tomorrow, I have another IV at the FFC, so I will ask them to send the info. I just worry that since they don't file insurance they won't be interesting in sending my insurance a letter.

    I am also concerned that insurance is going to pull the same trick for the IV treatments.

    I was wondering how many of you have had to battle insurnace for your treatments, and any tips you can offer.

    Thanks!
    Ellen
  2. Dalphia

    Dalphia New Member

    Blue Cross of Tennessee - PPO Coverage and they have so far paid 100% of the Quest Lab Test. However, I haven't been successful in getting the i.v.s paid. In fact, Tenn. BC/BS sent all of them back to me and when I called they told me that I had to file them through BCBS of Georgia since that was where I was getting treated (FFC in Atlanta). She explained the claims had to cross over from state to state for payments..........

    Strange thing is the very next day after I talked to the BC Representative, I received one check from BC of Tenn. office. I called them back and told them I was advised to not send my claims to Tenn. BC but to Georgia so how did I receive this check for one of the claims. Response was, she didn't know............

    As for getting a typed letter of medical necessity from your FCC in Texas, that shouldn't be a problem in that I was told by the Atlanta group they will do this in order to help us get reimbursed. So, you shouldn't have a problem. If I'm not mistaken, they will only type up one, so make copies of it in case BC looses it and you have to submit another one...........just thought you might need to know this..........

    Good luck and make sure you have everything on your claims completely filled out.....leave nothing blank...........they are so, so picky............and try everything to hold onto their funds..........just the nature of the insurance business!!!!!!!!!!!!!!

    Dalphia (Gaye)

  3. auntyemnga

    auntyemnga New Member

    Ellen,

    I have submitted everything so far to BC/BS of GA. For me, they paid 80% of the office visits and IV's once I met my deductible.

    Quest: Paid for all of the tests but 1. I think the charge was for $240. I was planning to call Quest tomorrow but I'm thinking I need to call the FFC instead now. Please update once you talk w/FFC so I'll know if I need to call FFC or Quest.

    Thanks & Good Luck,
    Sheila
  4. intrigue

    intrigue New Member

    I asked at the FFC, and they printed out two letters for me to send to my insurance. (The two tests in question were the Rnase-L test and the Natural Kill Cells Tot)

    I shall (make copies of them) and send them on to insurance and cross my fingers. :)

  5. auntyemnga

    auntyemnga New Member

    Thanks for the update!! I'll give them a call tomorrow.

    Sheila