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Inner-stem denied!!!!!!

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  • Inner-stem denied!!!!!!

    Well, my doc. office called Thursday (2/26) and informed me that BCBS had just called and told them they have denied my coverage for the inner-stem----then they called me back with an explanation, they said BCBS said it was still in the experimental stage!!! Can you believe that??????? IT was approved in 1999 for urgencey/frequencey. My doc. wasn't in Thurs. I was very upset all day. His nurse called me Fri. and my doc. is upset too-----He said that my ins. has approved several of these procedures, so now we have to start the process all over again!!!!!!!!! I have to go to the doc. Tuesday to talk and find out where we stand. This totally SUCKS!!!!!!!!!!! It took me long enough to make this decision and get myself prepared-----------I guess everything happens for a reason or at least they say it does!!!!! Just thought I would let everyone know!!! Has this happened to anyone and how long did the appeal take!!!!!!!!! cussing

    Tami
    tami[email protected]

  • #2
    Tami,

    My InterStim was approved, then I had it done, then it was denied. Well there are ways to fight this!

    1.) Ask your doctor to write you a letter stating that this is a necessity--other treatments have failed--have him explain YOUR condition better, and why you need this.

    2.) If they still deny, your company should have some kind of appeals process.

    3.) If all else fails, I went on a program called community care, where they erase your debt if your debt is large and you cannot afford it. Most hospitals do have some kind of arrangement as such, and it wouldn't hurt to look into.

    But most importantly, fight the insurance company. It took me a whole year to get them to cover IC issues, and they finally did, with a letter from my uro. Good luck, keep us posted!! If I can help at all, let me know.

    P.S. I think Medtronics has some kind of way to get the claim approved, try their site.
    Mommy to 2 crazy, wonderful kids and wife to the most amazing man in the world!

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    • #3
      The implant is still in experimental stages for IC...it is approved for urgency/frequency. It is possible that the doctor's office sent the insurance company the wrong diagnosis codes...if they hear IC instead of urgency/frequency they won't approve it. If you have voiding diaries that show excessive peeing and your doctor can help appeal, that will help. Jess has some great tactics as well.

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      • #4
        Thanks for the information!!!!!!! Yeah, Dr. Gray specifically specified that is was for urgency/frequency. He said that if you even mention IC they will deny it. They Medronic Rep. has already spoken with BCBS. I will know more Tuesday when I go to the doctor. I will keep you updated, until then I will just continue peeing all the time and continue to take my pain meds!!!!! If anyone else has any suggestions please let me know!!!! I hope everyone is doing well!!!!!!!!! hi angel

        Tami
        [email protected]

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