Need help dealing with Insurance

[Gelbandc]

I need expert help dealing with a never ending cycle of finger pointing. Blue Cross and Blue Shield has denied Radicava twice. I have one more chance to have a claim reviewed. The insurance company says the Dr‘s office didn’t do this or that and the Dr says they throw her office under the bus. I am caught in this cycle of he said, she said. Can anyone recommend an expert advocate to help me. I desperately would like to try this medication to slow progression. I am struggling with ALS and this added stress for the last 3 months is shameful.

 

[lisa g]

Do you have Medicare? My Medicare covers it first then my secondary picks up the rest.

 

[Clearwater AL]

Gelbandc, in the Search Bar (top right of page) type in....

Blue Cross Blue Shield Radicava. (Just hit Search itself.)

There are four Threads you may wish to read over.

 

[Gelbandc]

Thank you both…no I don’t have Medicare. I am still able to work (remote) - I am using medial insurance provided by my Employer. I did read the threads - thank you for the tip. Still reaching out to any savvy Insurance professionals or patient advocates ….I would Like to try radicava for my diagnosed ALS but I am continually getting denials and Dr/insurance company communication issues.

 

[lgelb]

Have you contacted Searchlight Support (the manufacturer's reimbursement support service)? They can try to help get reimbursement and provide financial support if you cannot obtain it.

 

[sassy]

I worked in medical insurance for many years. In order to go forward- you need to know exactly why Blue Cross is not processing the claim. Was it denied for lack of information or the diagnosis on file? If information- what specifically are they requesting from your dr?

Sassy

 

[Clearwater AL]

Gelband, just a thought... it could be that you are still working, not on
SSDI and is your Neurologist sending the correct diagnostic code for ALS.

Maybe questions to pursue.

 

[Nikki J]

Have you seen the prior authorization form for your insurance? Do you tick all the boxes? If you are newly diagnosed, meet el escorial criteria and are able to work you probably do but as Sassy says you need to know what the issue is

 

[Clearwater AL]

By any chance... are you a Veteran or Military Service?

 

[MToole]

Do you have a case manager? If not request one from BCBS.