6 replies to this topic

[Badger]

So, I had my second PCR of the year, and this time BCBS covered it. After the first one wasn't covered and my appeal denied, my onc sent a page to them from the National Comprehensive Cancer Network guidelines and highlighted the section entitled "Quantitative RT-PCR (QPCR) using IS." Today I found out that they covered the latest PCR. I still haven't heard anything about the one that I appealed. I'll keep you apprised.

[janne]

Badger,

This is terrific news ! it is also tremendously helpful for any others with BCBS in other states who have had this difficulty as well. I hope others find the same success in getting their PCR tests covered. I am still waiting to see if mine was covered this year. Thanks for the update. Janne

[Badger]

Here's an update. As I said, my latest PCR was covered, but my first one of 2013 was denied. Today BCBS told me that they reviewed coverage of this type of test and, as of April first, the test is covered by BCBS. However, they are still not covering the PCR I had in January, and they're making me appeal it yet again. Gotta love insurance companies.

[pammartin]

Excellent news!  I continue to fight for PCR coverage.  I have a host of denial letters from BC/BS.  They now have stopped paying for BCR/ABL the letters state the testing is experimental and unnecessary for the disease.  Huh?

So glad you have yours covered, with this disease the testing is a large part of the battle.

Pam

[Badger]

One final update. BCBS overturned their decision not to cover my first PCR of the year. Looks like I should be covered for the rest of the year. Between this and getting one of the Tasigna copay cards (mentioned in another thread), I'll be unexpectedly saving over $2000 in the next year).

[pammartin]

That's great news!!!!!!  congrats!

[Badger]

The best news is, our pharmacy talked to bcbs and got them to go back and give the discounted copay for the whole time I've been on Tasigna (since July of last year).