I would like to throw out the question once again: Are there any new or ongoing issues with claims denials from Blue Cross Blue Shield with any other states out there for PCR test claims?
My test from April is still under review.
I also had another discussion via email with the contact person at the BCBS TEC (technology evaluation site). Her second response to me is as follows:
"I am sorry that you did not find my first response helpful. There is not any BCBSA national reference policy that states that this type of testing is not supported by peer-reviewed literature. There is no TEC Assessment on this testing. We have not issued any information that states that BCR-ABL testing for CML is not medically necessary. Since each Blue Cross and Blue Shield Plan is independently owned and operated, the local Plan's policy is what would have been used to process your claim. That is why it would be best if you contact them." (See previous post http://community.lls...message/162559# )
I have not yet heard that other insurance companies other than BCBS are denying these claims, unless I have missed something.
I find it hard to believe that 39 states with BCBS plans are making this decision of denial of payment independently of one another and I have communicated that to the BCBS TEC people. I am wondering if anyone besides Badger has had any success in appeals on this subject. I know that PamMartin had hers denied. Marnie I believe had her copay increased. There was someone else who had commented and I do not remember who or which state.
Thank you for all your contributions !