pre=certification

[ENGINE85]

my husband had triple bypass surgery 4/1/09.  we have empire blue cross/blue sheild insurance.  he now needs to go to cardio rehab blue cross says they will pay for 36 visits.  we set up an appointment only to have it canceled because healthline states he needs a stress test.
wednesday he went for a nuclear stress test (3 hours) and became ill and we stopped the procedure.  healthline will still not allow him to go to rehab until he gets a stress test.
is this standard procedure.  it is now 5/23 and no rehab.

thank you for your help

[Amir Mostafaie]

Dear ENGINES85,

Asking your doctor's office to advocate on your behalf is a great idea, but I also recommend that you post your question on the Cardiovascular Disease Forum of MedHelp and ask a specialist if having a stress test before rehab is routine.

Sincerely,

Amir Mostafaie  

[HH5]

This is probably a case where you need to elevate the issue, and it is best done by your husband's doctor or nurse vs. you.  On the Blue Cross side, there is a nurse who should be reviewiewing this case -- a nurse-to-nurse conversation may provide the exception you need to get the rehab.

This might be a case of a front-line rep just following procedure.  He / she is probably doing their job, but this is not a normal case.  I'd have your doc or nurse call the insurance.

You may also want to post this over at www.healthharbor.com and see what kind of input you get.

[ENGINE85]

Thank you for your advice.  I think I may have trouble with asking the Doctor or his staff for help with this.  On my last visit (after I stopped the nuclear stress test) I had been speaking with BCBS regarding this matter and she put me on hold and spoke with healthline.  When she came back to me she said that if the doctor or his nurse would verify that he needed rehab without a stress test I would be covered.  I told the doctor this and he said he didn't like to tie up his staff with insurance phone calls that can take 20 minutes or so of time.  He wrote a prescription for rehab without stress test, but I was still denied.
I need rehab so I will have to have a stress test first I guess.  But thanks for trying to help with this problem.