Insurance claim for Protime

[mommywri]

I hope someone with experience in processing claims for medical supplies can help me out. We purchased a protime moniter in October 2002 and our insurer Cigna has denied both the machine and the cuvettes. When we called we were told by both Cigna and the company where my husband works that the machine should be covered because our insuance covers medical supplies. Well cigna requested information from QAS. According to QAS sales even though the information was requested in early December 2002, nothing has been sent to our insurance company. Does anyone know how to effectively expedite this? In addition Cigna has requested all medical records from my daughter's doctor. As my daughter has an extremely long medical record this is almost impossible (5 open heart surgeries alone are about an 8" thick part of the record). Do any of you insurance savvy pros have any suggestions?

 

[Gisele]

Not quite sure, but..

Not quite sure, but..

When I was going through trying to get BCBS of MA to cover my unit every time I spoke with someone I jotted down their name and the date and took notes about our conversation. Who told you medical supplies were covered-the employer or the ins co? I would take it from there.
I had to write a letter to the grievance dept at BC stating facts over why I needed this unit. If you are interested I could e-mail it to you so you can see the format I used. Supplies were also covered under my policy, but this unit was not yet recognized as a covered supply. BCBS now covers this product. Thank goodnesss as I test excessively due to erratic INR's. I just filled out my coumadin calendar for 2002 and I tested 100 times in 2002! My goal for 2003 is to try to stay more in range so I can test less often. (like I have any control over it-lol).
Good luck and let me know if I can be of any help.

Isn't the Protime company helping you at all? Did you ask them if they sent out the info yet to your ins. co? If so, ask for a date that it was sent and to whom ie dept, name. Ask a lot of questions and take a lot of notes.

Good luck.

Gisele

 

[mommywri]

Gisele,
Thank you so much for your help. I would love to have a copy of your successful grievance letter to BCBS of MA. My email address is [email protected]. It is so reassuring to me that you were able to get your claim paid. Again thank you!

Martha (mom to Christina mechanical aortic valve replacement 10/2/02

 

[Michele]

Insurance Claim for ProTime

Insurance Claim for ProTime

Martha,

There are a number of different ways that you can buy a ProTime monitor from QAS.

You can receive your monitor after you get insurance approval.

You can buy under our guarantee program (if there are no penalties from your company) where we will work on getting an approval for you for a year and if after a year you still don't get approval we will take the monitor back with a 15% restocking fee.

Or, lastly you can buy the machine outright and work on getting insurance coverage on your own.

What makes our company unique is that if we work on getting an approval for your machine we will take it to the appeals process if needed.

I do see in the notes on your account that Sheree from QAS has been working with your doctor and you trying to help you get the appropriate paperwork so you can get an approval.

 

[Randall Beckwith]

Protime testing

Protime testing

QAS was instrumental in me getting my machine at 100% from United HealthCare insurance. They made their case and United agreed. I'd go back to QAS. They want to sell a machine and your insurance company knows it will save them money as well as give you peace of mind. Let QAS fight the battle. Good luck.