HELP!! w/ BCBS Carefirst of MD PPO

Okay ladies (and gents) I have found out that I have coverage under BCBS of MD not DE and from what I'm told they are absolutely awful when it comes to getting approval for this. (great, just great - I knew this was going way too well). I spoke to Misty at Dr. Wynn's office and she told me that I now need to get all of this extra information together before they submit to the Insurance Company on Thursday. So in light of this discovery I am fully expecting them to deny my first claim and I have already started writing my appeal letter. Has anybody else had to deal with these people that can offer me some type of assistance or pointers for writing this letter? It would also help if any of you work for AZ because you'll know EXACTLY what I'm dealing with here. I'm starting it now because my surgery date is schedule for May 4 which will only leave me with 8 business days in which to appeal and pray for approval. (sigh) so close but yet so far.....

I work for AZ. Had my surgery just over a year ago. I also have BCBS. I had no problems at all. The only problem I had was that they didn't pay for PMRI. Catch up with me at work. We can do lunch. I'm going to email you my phone number etc. Ken

Hi Ken, You looked great Saturday! Are you able to file your PMRI stuff yourself with the insurance co? That's what I do and they pay me back at 80% Linda Seems that BCBS will participate with PMRI, it's PMRI that won't participate with them. Lot's of cases it's at least covered by a precentage, they just make you do the work.

Hi there Gawjus, We have BCBS of MD. Carefirst...it's MD Point Of Service....however, everything is billed through Delaware too for ours. All I had trouble with was waiting for them to clear it in 2 places, but I had no problems at all with them. Good luck! Linda

You will hate this reply. Yesterday was my surgery date and I am postponed because my Highmark Blue Shield (PA but a BCBS co.) just didn't approve. Mistee said it would take 48 hours but more like 4 weeks!! You probably CAN imagine how upset I have been. Trying to look at the upside -- not a denial, just a stopped clock! So now I went to work today, even though my work has been so postponed and delayed, and I'm waiting for a call (don't hold your breath about the return calls either) about timeframes and approvals. I'm not quite sure how they can give out dates and schedules without the insurance in place; no other surgeon would book up this way... So good luck, but don't count on that date, or the 8-day appeal. Wi**** were different... Please hope my approval comes soon and doesn't mess up another month of work/home/life juggling Carol

Yes their booking practices suck!! I think that both CHRIAS and PMRI are getting rich off of us because they know that we're in depserate need of help and are willing to do whatever it takes to get the surgery. So we end up paying hundreds of dollars in co-pays ofr visits to these specialists, $1200 to PMRI for these classes which to me were helpful but extremely repetitive (could really have been completed in 3 visits not 6) and then BAM!! Like a ton of bricks they hit you with a surgery date get you all excited only to pee in your cornflakes later on when you find out that a surgery date does not automatically mean that you're approved for surgery. I say we all write a letter or a petition or something. It may not be much help to those of us in the struggle right now but it may save someone else some headache down the road.