Insurance Question

[yorkieville]

Neeed advice from anyone that works for BCBS.

Over a year ago, my MS Specialist ordered 3 MRI's. I went to the same place I've gone for my previous MRI's. They claim they got the pre-certification from BCBS.

We recevied the Explanation of Benefits-BCBS stated they were paying for all 3 MRI's.

Months later, they sent us a new E.O.B. stating they weren't paying for one. Stating that only 2 are allowed in the State of IN. It's something new BCBS started.

My DH's Insurance Rep. has been fighting this for months, but getting nowhere.

So, is it legal for BCBS to originally give the pre-cert, then, later deny the claim?

TIA

Sheila

[yorkieville]

Sarah, I didn't take offense, and I truly hope you didn't take offense either.

Believe me, I'm not that kind of person.

I know, that my MS has made it difficult for me to word things the way I mean them. (:

Sheila

[SarahL2491]

no offense was intended, just saying fastest way to get an answer about precert then denial........was unaware of your forum status, I don't always go look people u before responding.  

[yorkieville]

Yes, Sarah, I realize we are only patients with MS-I've been a member of this forum for many years. But I do know there are members here who work for BCBS.

I've spoken with a member a few years back, just can't remember her name.

Thanks.

[SarahL2491]

I think your question should lie with the insurance commission of IN,
we are only patients who have MS............
we would have to be "up to date" on IN rules and such.

Good luck!