garrett in denver wrote:
Mello---thanks for the reply. I have BCBS, an HMO plan. Right now they have told me that they wont cover fixing a SH. I find that really hard to believe since it is something that causes me pain every day! Now that I have an official diagnosis, I am going to work with the Sports Medicine Dr. that I have been seeing who is "in network". This Dr. seems like she will be very receptive of Dr. M's diagnosis and will help me fight the case with BCBS.
How did you go about submitting the claim? Any words of advice? I have decided that I will have the surgery no matter what the insurance says about covering it. But I get more and more pissed everyday with the fact that I have good health insurance that says they are not going to help me with something that is causing me pain every single fu$%*#@ day?!?!?! Anyone know a good lawyer who deals with insurance companies? haha
I also have BCBS, but I have a PPO. Because UM is on the list of preferred providers that shouldn't make a difference unless with an HMO, are you required to get a referral in order to see a specialist such as UM. With a PPO, I wasn't required to do so.
As for claim submission, I notified the Mondial rep and forwarded him copies of UM's diagnosis, the hospital bill and proof of payment. I also mailed the above information to the BCBS claims department for processing in addition to some required forms you can find on the BCBS site.
I'm putting in a call today to check the status. More info to come.