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TTC after 35
Blue Cross = fail
Hi ladies-
So I got the letter from BCBS regarding my doctor's appeal and they are still denying me. They are not acknowledging my cervix issues and they will not pay for ANY IF services.
I had called BCBS myself this week and asked why it was denied if it says "Patients over 35 may be considered IF after six months" (I'm paraphrasing, but you get the idea) on the front page of their IF literature?
She talked to the department and they said "we don't do that." I asked her why it says it on the literature if they don't do it. . . and she had no answer for me. I also asked her why other women in my practice are approved after six months if they don't do that and she had no answer.
I left a message at my doctor's office to see if there is anything else we can do.
I am sure there is nothing else we can do and I feel utterly defeated.
I leaving tomorrow to meet DH in New Orleans tomorrow. I was so excited and now I just want to cry in bed all weekend.
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Re: Blue Cross = fail
Hi there,
I would definitely look at your insurance policy and make sure that you follow the Blue Cross internal policy for an appeal or reconsideration of the denial of coverage. There is usually a specific period of time per the policy, you want to make sure that you follow up before that time lapses for any appeal of the decision.
I'm not sure what your state laws are, but you may be able to appeal the denial to your state agency directly as well (Department of Insurance).
Definitely do not give up, if your policy provides the coverage, then you should demand a specific explanation as to the denial and a review. It looks like your doctor is willing to help you, so keep them in the loop and see if there is anything else that they can help you with.
Good luck!
RedSox-
Whatever you do don't give up. This is discrimination if you ask me. Maybe even if you just say the words "my lawyer will be contacting you for better explanations" they will provide some better answers for you. Go on down to Bourbon Street and have a blast with your hubbie and then come back recharged and ready to fight like hell. I've got your back!!! GL
oh wow. i can't believe they denied you. BCBS bites even more than I thought they did.
are you on DH's insurance or your own policy? is it possible you could switch insurance cos. by doing something like that and get better coverage?
when DH and i started out with fertility treatments he was on an HMO at his co. It bit cause they hardly covered anything, had to get referrals, etc. Thankfully he switched jobs a few months later and knowing we needed fert. treatments we switched to a PPO - and it was a different insurance co. with better coverage. We were also in the midst of potentially switching again, to the insurance co. my company uses, but didn't have to in the end.
if you can't switch i've heard there are possibly ways to get free fert. or much cheaper treatments. i've never looked into this at all, but i know i've seen it on other boards.
and like the others said i would continue to fight with BCBS and check out other options as well. all the best.
This x's10.......... enjoy NO, relax and have fun!
I'm just so, so sorry that you have to deal with this. It sounds like they are just being a$$holes just because they can be. I know it can be so frustrating to deal with. I've had similar problems with my insurance regarding my meds and I get a different explanation from every rep I talk to over there..........it makes me wonder if these people are just making it up as they go along!
I hope you enjoy your time in New Orleans with DH........sounds like you definitely need a break! Hopefully you'll come back with more determination and fight power......don't give up!!
I'm sorry.
I agree with the advice given here. I think it's absolute BS that their policy states one thing and they say another but can not give you an explanation as to why the two are completely different.
Don't give up Red!!!
Have fun in New Orleans!!!!
BTW, I also live in a state that mandates coverage for IF treatments, however, there are loopholes. In NJ, they do not have to cover IVF treatments for those people at companies with less that 50 people subscribed to their insurance (that's me!) or for companies who have a self-funded plan. You should see if you fall into any possible loopholes......they HAVE to give you a reason why coverage was denied. As the PP states, see if DH's plan is better (even if the premium is more expensive), in the long run, it may be worth it. With my plan, they will cover unlimited IUI, but NOTHING for IVF.........strange since they may end up spending more on 10 IUI's with no results than ONE successful IVF!!
Ive had two huge emergency room bills denied by BCBS. They said it was an exclusion in my policy. After arguing for a year with the first one I filed a complaint with the Ill department of insurance. BCBS paid the day they recieved the complaint.
The 2nd ER they denied I didnt even call them. I filed a complaint right away. This time it took about a month but they paid. NOW they are denying my follow up appointments. Just faxed my complaint in and we shall see what happens. They Lie like hell and just suck! GL!
That is really really crappy. UGH =( I think the previous posters have all given great advice. I also recommend calling your doctor's office to see how else they can help you. When insurance denies a procedure/etc. for my patients, and I know it is something we need to get done, I will write letters, ask to speak to the medical director at the insurance company, etc. Someone in your doctor's office may be able to guide you regarding next steps to take. GL!
Have a great time in New Orleans!
Thanks for all the support ladies! It is so nice to have a safe place to vent.
I have a call into the doctor (they are great and I think they'll get right back to me).
I am going to keep fighting. Thanks for all your suggestions. You are all so wonderful!
I'm so sorry - we really don't need to deal with insensitive insurance companies on top of what we are already dealing with.
I hope you have a wonderful trip and can put this out of your mind for a few days.
Are you looking into alternative ways of paying? Can you pursue insurance and private pay at the same time so you don't have to wait? I don't live in a state that mandates IF coverage so no one here ever gets it covered and there are lots of finacing alternatives - don't know if you have that available to you. The rules keep changing but I believe you can take the money out of your retirement fund penalty free for this??
My stomach just churns reading this and am so mad for you. I hope as pp said that you continue to fight...they just want you to give up and go away. They more pressure you put on them, the better...especially when you live in a state where it should be covered.
I truly hope you can put this to the back of your mind for the weekend, enjoy a fabulous time in NO with your DH....eat lots, drink lots and enjoy the music....then come back with a ragin' cajun attitude and give them hell.
This exactly! I think my blood pressure just went through the roof reading about the insurance company being such huge a$$holes. That just astounds me that they can get away with it. I have faith that you will be able to get things done with the help of your doctor's office. Good luck.