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Author Topic: Appealing to Blue Cross Blue Shield  (Read 1664 times)

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Offline allstardiva2005

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Appealing to Blue Cross Blue Shield
« on: October 19, 2007, 10:07:35 PM »
Hey everybody,

In early August, my surgeon (Dr. Noyes) and I decided to finally go ahead with my meniscus transplant next summer, my 10th knee surgery. We heard back from Blue Cross Blue Shield (PPO - Michigan) that they have denied my claim as this surgery is still considered experimental. When we had made the decision, he told me I would probably have trouble with BCBS as it is one of the three worst in the country (despite BCBS being the best the state of Michigan has to offer).

My surgeon said the next step is to write the biggest sob story I can come up with for BCBS. Has anyone had to do this and what did you write/say?

I obviously need this surgery as I've been in daily pain since 2003 and I'm only 20 years old right now.

Thanks for your help!
Medial Meniscus Repair- '00,03
Partial Meniscectomy- '03, '04
ACL Reconstruction- '02
Exploratory Scope- '05
Allograft ACL Revision & Neuroma Excision- '06
Hardware Removal & Bone Filing- '06
Scar Tissue Removel- '07

** Medial meniscus transplant is in the near future... **

Offline Nettan

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Re: Appealing to Blue Cross Blue Shield
« Reply #1 on: October 19, 2007, 10:15:00 PM »
I have not claimed for surgery but other issues.
Write them a letter expressing how you are today, how your latest years has been, what you want your future to be..and how that will become without the surgery. That can involve issues like what you want to work with in future, making a family, interests.
I would really encourage you to write down every now and then what you are thinking of and then put all together.
A great tool is the computer. Best wishes for you.
Surgery 6 times left knee torn meniscus, RSDS,chondromalacia, nervdamage cause constant nervpain,chronic inflamm.
Spinaldamage wheeler 100%.
Right knee damaged aug-06, use brace surgery 4/9-07.LCL tear.

Offline jathib

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Re: Appealing to Blue Cross Blue Shield
« Reply #2 on: October 20, 2007, 12:49:42 AM »
Your doctor should also be in the fight with you. My family doctor is a master at handling my insurance company. But don't be surprised if you lose. Many insurance companies won't pay for experimental surgery. And that particular surgery is not all that successful anyway from everything I've read so you could end up going through all that and still being in pain anyway.