ERD50
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
AARGGGGHHHH!!!
I did not know if BCBSIL had any age restrictions on shingles vaccination, so I called their customer line. The person told me that it is 100% covered, no copay, nothing. I asked if I could go directly to a Costco Pharmacy, he verified they are in the network, and even gave me the address of my local Costco (I actually wanted him to give it to me, even though I know it of course, just to validate that he told me I could go to that specific one).
So I go to Costco a few days later (8/25), they said they would have it preped in 30 minutes, I came back and they ring me up for $217.05. They said it was denied, and I explain it should be covered. They say I could skip the shot, but I decide to pay, and deal with insurance later (big mistake!).
I call BCBSIL, they don't seem to have any record of it being requested, declined or anything, tell me to wait for the EOB to come through. Well, weeks go by, no EOB. So I call and explain, it took some time for them to decode the codes I had on the receipt, but this 2nd person told me it was submitted as a pharmacy claim, and I need to submit it as a Medical Claim (fill out a form, attach original receipts, mail it in), and she assures me it will be covered given the circumstances. I submit on 10/1. Two more weeks, and that gets denied.
More emails, and they say I needed my PCP approval before getting the shot. Well, they never told me that when I called, or when they asked me to submit more paperwork. I had ref #'s/names/dates for the calls. Another review (and they won't give me any no promise date for the review), and another DENIED.
Can I escalate this somehow? It just doesn't seem right that I call them, do exactly what they tell me, twice, and I'm still denied. It's not always easy decoding their documentation, I thought calling was the right thing to do. But I guess like the IRS, they don't necessarily give the right info, and they aren't responsible for giving wrong info? IS BCBSIL particularly bad in this regard, or are they all the same?
-ERD50
I did not know if BCBSIL had any age restrictions on shingles vaccination, so I called their customer line. The person told me that it is 100% covered, no copay, nothing. I asked if I could go directly to a Costco Pharmacy, he verified they are in the network, and even gave me the address of my local Costco (I actually wanted him to give it to me, even though I know it of course, just to validate that he told me I could go to that specific one).
So I go to Costco a few days later (8/25), they said they would have it preped in 30 minutes, I came back and they ring me up for $217.05. They said it was denied, and I explain it should be covered. They say I could skip the shot, but I decide to pay, and deal with insurance later (big mistake!).
I call BCBSIL, they don't seem to have any record of it being requested, declined or anything, tell me to wait for the EOB to come through. Well, weeks go by, no EOB. So I call and explain, it took some time for them to decode the codes I had on the receipt, but this 2nd person told me it was submitted as a pharmacy claim, and I need to submit it as a Medical Claim (fill out a form, attach original receipts, mail it in), and she assures me it will be covered given the circumstances. I submit on 10/1. Two more weeks, and that gets denied.
More emails, and they say I needed my PCP approval before getting the shot. Well, they never told me that when I called, or when they asked me to submit more paperwork. I had ref #'s/names/dates for the calls. Another review (and they won't give me any no promise date for the review), and another DENIED.
Can I escalate this somehow? It just doesn't seem right that I call them, do exactly what they tell me, twice, and I'm still denied. It's not always easy decoding their documentation, I thought calling was the right thing to do. But I guess like the IRS, they don't necessarily give the right info, and they aren't responsible for giving wrong info? IS BCBSIL particularly bad in this regard, or are they all the same?
-ERD50