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Insurance Coverage for PAE

Posted , 6 users are following.

tim_1948
tim_1948

Has anyone in the US succeeded in getting Blue Cross to approve and pay for a PAE for BPH? Thanks

0 likes, 11 replies

11 Replies

  • Waffalobill
    Waffalobill tim_1948

    Posted

    Good luck. They fight with me on every claim. Make up stuff to. Claim docs out of network when there not. After I prove them wrong using there own website. They claim I never submitted paperwork. Then prove that to be a lie. Deny me meds even after meeting criteria set by them.
  • ramblin
    ramblin tim_1948

    Posted

    My insurance is GEHA, or Healthlink. They paid for mine in 2015. By the way, it did not work, and now I'm planning on Urolift.

    • lester90053
      lester90053 ramblin

      Posted

      This is the reason why most insurance excludes newer procedures. Either they are experimental or they have not stood the test of time.
    • Waffalobill
      Waffalobill ramblin

      Posted

      2015 they paid for my meds no questions asked. As of 11 months ago they started denying them or decided I needed 1 a day instead if 2 a day as prescribed. Pinching pennies.
    • Waffalobill
      Waffalobill lester90053

      Posted

      Newer procedures described as better and less invasive always cost more. They don't care about how you feel or pain level. Don't really care about outcome either. I met my deductable last year on meds. Had no co pays on scripts. They paid full shot. That's when they really got nasty. Refused my GP script, my specialists script. Even after my condition was confirmed with upper endoscopy and found Barrett's esophagus. Met all criteria set forth by them and the manufacturers guidelines for dosage. Appealed half dozen times. Still denied. The condition will now get worse and cost them more than the meds cost.

    • lester90053
      lester90053 Waffalobill

      Posted

      Have an insurance specialist review your policy to see what is excluded.
    • Waffalobill
      Waffalobill lester90053

      Posted

      The insurance companies board decided I didn't meet the medical necessity standards. Even sent to independent review board.

    • tim_1948
      tim_1948 lester90053

      Posted

      Yes, already done. They turned down again. It was like they didn’t even hear what he had to say. 
    • Waffalobill
      Waffalobill lester90053

      Posted

      Did it. Even had to sign a release for my doc to represent me. Spent almost a year doing all the things needed. Still lost. Proved acid is eating my throat. Still denied. Doc said he has patients take meds cost 10 times what we requested. Never had a insurance company refuse cheap meds like blue Cross is.
    • lester90053
      lester90053 Waffalobill

      Posted

      Time to change insurance companies but make sure you discuss what is covered and what is not, especially your present conditions.
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