Claim denied...I hate BCBS, need some help!

I hate to be someone that just shows up when they need something...but I couldn't think of anyone else to turn to!  BurbanDude had another flair up and his Neuro suggested Solu Medrol IV therapy for 1 week, the dude freaked when he heard about the IV part.  So the Neuro suggested that he ingest the medication stating that he would absorb 80% of it anyway, dude was relieved!  

Apparently, BCBS will not cover the medication because it is an injectable medication!  Has anyone taken the medication this way before or seen any documentation of alternative administration online.  I'm filing an appeal and need all the ammunition I can get!

I'm so angry because we saved them nearly $5500 by not going to the ambulatory infusion clinic for 5 days! Next time I will be sure to stick them with the most expensive treatments possible!

[julia111]

I don't know anything about the injectables  . . .

. . . but it took me two weeks to get BCBS approve LYRICA.  

With a little help from my Doctor and nurse . . . we finally got it approved . . . and unfortunately, I couldn't function on it and stopped taking it after 5 weeks.

Anyway . . . KEEP TRYING . . . they probably try to get away with whatever they can hoping that you won't pursue!

Hopefully someone else will come along and shed some light on getting the injectables covered.

Good Luck!

[Fluffysmom]

I hope someone comes along soon with information that can help you fight BCBS and get the medication approved.

I have BCBS as a Medicare Supplement, so I haven't had too much trouble with them so far; just had to get prior authorization for my Prevacid.

My best friend, however, has a pituitary tumor that blocks the production of hormones, and has been using injectible human growth hormone for years.  The company she works for switched to BCBS, and they won't cover the Nutropin (sp?) with help for doctors, the company that makes the medicine, and appeals.

She is now getting help through the company; they have a program that helps people that are underinsured.  She just has to send them her last tax return, and they already have the information about how it's medically neccesary.  She has been rationing her last vial of injectibles and is feeling absolutely awful.  I hope the paperwork gets processed soon and she gets her meds!

Maybe the company that makes the Solu-Medrol has a similar program, and can help you out.  Try calling the company, and do an end run around BCBS; they'll give them heck, too.

Best of luck,

Kathy

[Amyloo]

I would suggest also that when you write your appeal letter, you "cc" everyone under the sun.  Like the American Medical Association, your state Insurance commisioner, your state congressman, etc.  Insurance companies do not like it when they know they are being "told on".  Puts them on notice.

I had to fight same insurer for an MRI of breast; I chose to go ahead and have it done even though the appeals process was still ongoing, and I did not know if they would cover.  Turns out I had a tumor (benign) that showed up on on MRI that did not show on mamogram (mammogram).  Had to have it biopsied.  They covered everything.