Blepharospasm Bulletin Board

insurance snafu BOTOX
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Posted by: Elizabeth
01/30/2004, 13:39:23


Hi, I am new to the BB. I am 56 and was diagnosed with blepharospasm by the otolaryngologist who diagnosed and treated my spasmodic dysphonia. I have been treated successfully with BOTOX injections for five years, about every five months, by a doc at Geo Wash Univ Hosp who is bd-cert in neuro and ophthal. Botox injection has been a huge success for me; prior to treatment I had been unemployed for two years. I was soon able to return to my usual condition of being about 200% employed!

On a form dated 11/20/03, Carefirst BlueChoice, my insurer, rejected the hospital's claim citing code M729 citing maximum lifetime benefit as determined by "an internal rule, guideline, or protocol..."

The Hospital, which I had believed to be a cooperating Carefirst provider, and judging from the insurance form so did Carefirst, who listed "patient responsibility" as $88.60, has been trying to collect an amount of more than $1,000 from me personally, including turning it over to a collection agency. I would have gone on and paid them, except that I did that in a previous mixup over a mis-coded bill that needed to be re-submitted, and then every time I tried to call billing about it I was told, "Oh, don't worry, that is already paid." click.

Has anyone else experienced any lifetime max being imposed for botox benefits by their insurance co?

I have, by the way, not received more than three botox injections other than the ones for my eyes because the vocal injections were such a mixed bag.

I will be requesting a copy of the internal ruling and will let everyone know what it says.




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Life time max ... uh-uh!!!
Re: insurance snafu BOTOX -- Elizabeth Top of thread Archive
Posted by: Moderator-JB
01/30/2004, 19:40:13


Elizabeth,

The hospital miscoded it. Hands down, the best way to take care of it is to be 'in their face' literally. If that is not possible, state everything, step, by step in writing and send it to them. Keep copies. Call and ask for the billing supervisors name (before you tell them who you are) and either/and or talk or write to her specifically.

If that doesn't work, start from the top (Admin.) and slide down the chain of command with names. Always keep and use names.

Take care and e-mail me if I can help further. (I was an Insurance Agent and also a benefits co-ordinator) in a past lifetime.) Means I got to yell at people and make them fix problems.

Judy
blkmn36@earthlink.net



Modified by Moderator-JB at Sat, Jan 31, 2004, 13:52:31

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