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Insurance Hell All insurance-related matters are here: Medicare, worker's compensation, appeals, denials, insights, wins, losses. PRICING is here too. Note: This forum has posts from 2006 forward. Older ones are in the Big File.


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  #1  
Old 10-27-2014, 02:26 PM
Throttlejockey Throttlejockey is offline
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Join Date: Jun 2014
Posts: 52
Default BCBS WW - Process

Dear All,

Just finished filling out the claim form for the overseas ADR with BCBS WW. However, before I get the ball rolling and send this thing in, I figured I needed to get my ducks in a row and get educated.

I need to get a copy of the "playbook" (rhetorically speaking!!) so that I can "DIRT FT" (Do It Right The First Time).

If anyone would be so kind as to guide me through the process, what I should supply them with and what I should avoid at this stage. What to expect, etc. etc.

Also, I figured I will need to begin putting together my case, with all sorts of back up materials, etc.

Any help is appreciated.

Dave
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- Wife has been diagnosed with Severe Spinal Stenosis Right and Left Sides, Degenerative Disk Disease at C5/6 and C6/7, Large Osteophyte Complexes at a both levels, with C6/7 on R/H Side, and C5/6 both R/H and L/H Sides. Also Reverse Lordosis.
- Performed 2-Level ADR with M6-C by Dr. Clavel, Barcelona Spine Center on 10/15/14.

Last edited by Throttlejockey; 10-27-2014 at 04:01 PM. Reason: typo
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Old 10-27-2014, 08:25 PM
Jerry5 Jerry5 is offline
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Join Date: May 2013
Posts: 363
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Get ready, I did all the Pre stuff, fought them tooth and nail, even paid for for the material for an appeal.
No luck.
Went to Germany, paid for it, and when I came back submitted the reimbursement.
They paid their portion of the hospital bill, but are only paying a small portion of the surgeon's fees, they claim they were out of the network, and the amount was beyond my allowed amount.
What is 'allowed'?
So, I am fighting the surgeon fee, and make sure you can document what you did, what type of procedure, and try to give some amounts in US equivalent, such as an adr here might be $50K US and over there it might be $30K, or something.
Be prepared, they most likely will not pay.
But you can take all of this on your taxes.
I am not sure, if you can spread this over more than one year, but most of us do not make enough to absorb all the expenses, but EVERYTHING is deductible.
Good Luck.
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Jerry, Somewhere Ohio

L2-3 herniation, two days before Thanksgiving, 2012, Discectomy/Laminectomy, 3/13 Numbness in the right leg, lateral femoral, gone, July 10, 2014 L45 M6 ADR, July 15 PLIF L5-S1, Not able to access L51 Anterior.
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