Question:
HELP! APPROVAL from BC/BS of Texas for PANNI???

I just received denial for tt by BC/BS of TX. I provided letter from DR re: medically necessary & rash photos. Our company contract w/bc/bs ends @ end of Dec-feel they are refusing approval because of end of contract. If you have been approved by them, PLEASE, PLEASE provide what you/your doctor submitted and if possible a link to your letter/info which provided that approval. THANKS FOR YOUR HELP!! Any additional suggestions would be appreciated!    — Pat B. (posted on November 12, 2004)

November 13, 2004
Hi, I am in the same boat as you and I have BC in Pennsylvania. I have been told by the surgeons office that in all of 2004 they haven't had any patients approved by BC for this procedure. I just sent my second appeal this week. I would be greatful if I can get any useful information myself on anyone that has been approved by BC.
   — SINDI W.

November 13, 2004
I have had a terrible time with BCBS-Texas due to their delaying tactics. Patients who clearly need a panni may have to wait a month simply for BCBS to get the letter "in the system." The most common reason for denials is "failure of conservative therapy"...in other words they want to evidence of a rash AND non-surgical treatments tried for 6 months before going to surgery. Find out WHY they denied you..they have to say. This is the key to getting a good appeal. Other patients/doctors letters MAY be helpful, but I discourage this approach because your case may not be similiar, different company, etc. Your insurance coordinator at the doc's office should be your best ally and advocate here.
   — DrL