Need help dealing with Insurance

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Gelbandc

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Joined
Jan 28, 2021
Messages
2
Reason
PALS
Diagnosis
10/2020
Country
US
State
PA
City
Eagelville
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

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Joined
Apr 17, 2019
Messages
403
Reason
PALS
Diagnosis
04/2019
Country
US
State
FL
City
Fort Pierce
Do you have Medicare? My Medicare covers it first then my secondary picks up the rest.
 

Clearwater AL

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Joined
Aug 28, 2013
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PALS
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Get Real
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

New member
Joined
Jan 28, 2021
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Reason
PALS
Diagnosis
10/2020
Country
US
State
PA
City
Eagelville
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

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Lost a loved one
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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

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Joined
Apr 22, 2018
Messages
91
Reason
CALS
Diagnosis
02/2018
Country
US
State
RI
City
East Greenwich
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

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Aug 28, 2013
Messages
2,100
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PALS
Diagnosis
12/2016
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Get Real
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

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Joined
Mar 22, 2012
Messages
10,694
Reason
PALS
Diagnosis
04/2014
Country
US
State
MA
City
Boston
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

Very helpful member
Joined
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Messages
2,100
Reason
PALS
Diagnosis
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Country
US
State
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City
Get Real
By any chance... are you a Veteran or Military Service?
 

MToole

Active member
Joined
Apr 16, 2016
Messages
85
Reason
PALS
Diagnosis
02/2012
Country
US
State
IL
City
Elmhurst
Do you have a case manager? If not request one from BCBS.
 
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