Bcbs denied home health coverage. Suggestions?

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ade7682
Posts: 57
Joined: Tue Aug 16, 2011 7:55 am
Facebook Username: ashley.danielle.eldridge

Bcbs denied home health coverage. Suggestions?

Postby ade7682 » Sat Aug 20, 2011 7:48 pm

Bcbs of nc denied claim for home health nurse to disconnect chemo pump over weekend after we had gotten it pre approved prior to 1st visit last weekend? Suggestions for appealing claim? We were trying to do chemo on Fridays and over weekend so my husband could rest before having to return to work Monday. He's on Folfox w/ Avastin.
7/16/11 colon resection, 3 cm tumor obstructing
8/5/11 stage 4
8/12/11 Folfox/Avastin
1/23/12 8 met liver resection/abation
3/9/12 lt lung resection
4/12/12 folfiri
5/12 clot in port vein
5/21/12 new port placed
8/12 rt lung resection, resume folfiri

lydia123
Posts: 771
Joined: Sun Jul 04, 2010 11:23 am

Re: Bcbs denied home health coverage. Suggestions?

Postby lydia123 » Sat Aug 20, 2011 7:52 pm

I don't have any advice, but I can tell you that a friday schedule worked for us. We have BCBS FEP and did have coverage on Sundays for the disconnect in Virginia. It is a common schedule here in DC.
lydia123
caregiver to husband dx stage III colon/rectal cancer 5/10
6/10 surgery
7/10: FOLFOX began -- became nausea management expert
12/10: Chemo-radiation ended, scans clean.
NED since, but some scans required follow-up

Holly
Posts: 537
Joined: Thu Sep 08, 2005 11:06 pm

Re: Bcbs denied home health coverage. Suggestions?

Postby Holly » Sun Aug 21, 2011 10:09 am

Wow...lots of strong insight and great advice. However, I can appreciate why someone may be a bit apprehensive about self dc of pump. To all those non medical persons and non rocket scientists out there...a personal scenerio to hopeful reframe this posters concerns: 4 weeks post dx and you learn your port has become infectected, must be removed, and replaced. Alrighty, port #2...you as the patient dx with stage 4 cc now is at home no one getting near port #2 and you have TPN to feed you, supplement for tpn, also in the refrigerator you have bags of flagyl, vancomycin to be titrated, you have syringes filled with zofran, benedryl, supplemental morphine, heprin and normal.saline just to name a few. Now were do you start? Do not forget morphine and heparin are not friends.

I offer this to those who are quick to write "its not a rocket science." While, it may be easy for some, I do not believe it would be unreasonable to to unreasonable to want a professional to assist. There are always exceptions, nothing is absolute in this context. Perhaps you could ask your husbands doctor to recode the medical nessessity of the need for home health.

I will keep you in my thoughts and prayers! All things are possible if you believe. By the way, welcome to to the club. My name is Holly, I am an eight year stage 4 cc survivor NED.

Hugsxxoo

Holly

ade7682
Posts: 57
Joined: Tue Aug 16, 2011 7:55 am
Facebook Username: ashley.danielle.eldridge

Re: Bcbs denied home health coverage. Suggestions?

Postby ade7682 » Sun Aug 21, 2011 7:16 pm

Thanks, Holly. I also thought I might ask the home care agency to bill using a different code.
7/16/11 colon resection, 3 cm tumor obstructing
8/5/11 stage 4
8/12/11 Folfox/Avastin
1/23/12 8 met liver resection/abation
3/9/12 lt lung resection
4/12/12 folfiri
5/12 clot in port vein
5/21/12 new port placed
8/12 rt lung resection, resume folfiri

MrPleistocene
Posts: 263
Joined: Wed Jul 28, 2010 9:04 pm
Facebook Username: vinson.jim
Location: San Diego, CA

Re: Bcbs denied home health coverage. Suggestions?

Postby MrPleistocene » Sun Aug 21, 2011 9:59 pm

I'd definitely check with the home health people too. Tell them that insurance denied it so you can't schedule, but if they can get it pre-approved, you can resume service. It is in their interest to get it approved as well. If you get them going to bat for you too, that might help.

Good luck.
DX 11/09 RC Stage IIIb
12/09 Chemorad w/Folfox
Surgery 4/10 LAR, Removed Seminal Vesicles
Clean Margins, T3N2M0, 4/19 Nodes
FOLFOX 6/10-11/10
6/10, 10/10, 1/11 Clean Scans, Normal CEA
12/10 Bi-Nephrostomy
12/10-2/11 HBOT
2/11 Reversal

Holl

Re: Bcbs denied home health coverage. Suggestions?

Postby Holl » Wed Aug 24, 2011 10:54 pm

MrPleistocene wrote:I'd definitely check with the home health people too. Tell them that insurance denied it so you can't schedule, but if they can get it pre-approved, you can resume service. It is in their interest to get it approved as well. If you get them going to bat for you too, that might help.

Good luck.


You are welcome and hope you get some assistance with recoding your home health claim.

Hugsxxoo

Holly

Holly
Posts: 537
Joined: Thu Sep 08, 2005 11:06 pm

Re: Bcbs denied home health coverage. Suggestions?

Postby Holly » Wed Aug 24, 2011 10:57 pm

You are welcome. Good luck!

Hugsxxoo

Holly

beth568
Posts: 961
Joined: Fri Mar 25, 2011 7:49 am
Location: Boston area, MA

Re: Bcbs denied home health coverage. Suggestions?

Postby beth568 » Thu Aug 25, 2011 7:45 am

I'd also ask your doc if there are social workers in the cancer center who can help you with this. At MGH we've got a great SW who undergoes all kinds of battles with insurance companies, and usually wins. She helped me with a prescription issue and had it resolved within 24 hours. People who are used to navigating the system know all the right tricks.
Beth
dx @age 42, Jan '11 RC, T2or3NxM0 (stage IIIA/IIIB)
6 wks chemorad Feb - Mar '11
LAR 5/23/11, staged T2N1bM0 (2 of 15 nodes positive)
8 rounds FOLFOX, June-Oct. 2011
clear scans Nov '11, May '12, Nov '12, May '13
http://www.mysemicolon.net


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