27 replies to this topic

[Susan61]

Hi:  Just following along with all the different posts regarding this issue.  I have Aetna Insurance, and I did get a increase in my cost for PCR testing.  They are charging lower fees for some tests, and other fees are higher.  I think I payed close to $50.00 for my last PCR test, where I was paying only $30.00 last year.  I am not due for a PCR test till July, but now I am curious.  All my prescription costs have gone up, but compared to what I see everyone else is paying mine is not that exorbitant.  Does anyone else have Aetna and Medco?  I know I have seen some with Medco, but not necessarily Aetna.  I used to pay $20.00 for every lab test, but now with the different rates it sort of balances out at the end.  Things I was paying $20.00 for in some cases is lower.  I live in N.J., maybe the state you live in does matter?

[chriskuo]

Badger,

Has your appeal been processed?

Don't they have to provide a decision within 72 hours?

In similar cases, I have found that you have to push hard and push up

Until you get a plain English answer.

In a situation I am working on, the contract between the insurance company and the company

Sponsor has conflicting statements internally and with Medicare regulations.  It is very frustrating

To get anybody to take responsibility tor these discrepancies but after 3 weeks of pushing

4 organizations, I got my drug copay (for this month at least) reduced from $432 to $45.

[Cks]

I live in Illinois and have a BCBS IL policy.  We are self employed and the policy is

purchased by us.  No HR department to help with the issue.  The bill I received for the non-covered charges is $1,355.50.  I have been talking with BCBS and the Dr. office.  The claim has been reviewed a couple of times and receives the same denied status.  Dr. Office agrees it should be paid and that there is a coding issue but I am beginning to think it is more than that.  Has it really become a non-covered test because of all the Ins changes?  In which case, we would need a "bigger" voice to speak up for us. 

[Badger]

My appeal has been denied. My onc has requested that I provide the documentation related to the appeal and is going to look into it. His nurse mentioned the possibility of his doing a peer-to-peer with someone at BCBS. If everything else fails, I have the option of appealing directly to the company I work for.

[Badger]

Has anyone that doesn't have BCBS had trouble with their PCR being covered? Also, for those on Medicare, is the test covered?

[pamsouth]

Medicare;  Turned 65 years this pass January, so my primary insurance is Medicare.  Just make sure the blood test is processed where Medicare has a contractional agreement with them.   Than they/lab have to except whatever Medicare allow, and it isn't much that theyMedicare pays.  I had my first PCR this year at Indiana University, Indianapolis.  Medicare paid a pityful small amount of the labs, PCR, FISH, ETc.  I called Medicare just to make sure I didn't owe anything, they said no, I went to hospital/clinic that agreed to accept the allowable amount.

Pam South

[hannibellemo]

Just found this on line from Aetna listing the selected indications for BCR-ABL by RT-PCR, dated March of 2013. Don't try and print the whole thing - it is over 90 pages long

.

CML is listed under leukemia. Why would one large insurance company recognize the worth of PCR for CML and not BC/BS?

http://www.aetna.com...0_699/0650.html

Pat

P.S. I was trying to figure out how I could get more acronyms in my post - anyone want to give it a try?

[Badger]

Is anyone on Medicare have issues with their PCR being covered?