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LINX denied by insurance

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Posted 6/10/2013 3:35 PM (GMT 0)
I know about this forum from months of LINX research. It's definitely time to ask this group about my dilemma.

My doctor utilized the third-party expediting company that I believe the LINX manufacturer has hired. I think Pinnacle is the company. My BCBS company denied my LINX predetermination anyway. So now I'm at the point of appeal and not sure how to proceed. BCBS says Peer-to-Peer between my doctor and the Medical Director is next. After that would be a formal appeal.

My obvious and immediate need is to understand if anyone has been through this and what feedback they might have. Thanks in advance.

-Rob
Posted 6/10/2013 6:17 PM (GMT 0)
I had the same problem with Blue Cross Blue Shield back in April - I live in Massachusetts.  They originally approved the procedure and then revoked it the night before the surgery was scheduled.  I was not happy to say the least!  My physician appealed and they refused to budge.  I ultimately decided to go ahead with the Nissen Fundoplication which I had done on April 16th.  It's pretty sad when insurance companies, not doctors, make decisions about our healthcare!  I am afraid things are only going to get worse in that department.

Stacey

Posted 6/10/2013 10:18 PM (GMT 0)
I was denied by BCBS-MN last fall, and then again this spring, after which it went to an external agency through the Minnesota Department of Commerce. the agency which handled the appeal was called "Maximus." The third appeal overturned the denial saying that the procedure is not investigative.
Posted 6/10/2013 11:47 PM (GMT 0)

dholmb said...
I was denied by BCBS-MN last fall, and then again this spring, after which it went to an external agency through the Minnesota Department of Commerce. the agency which handled the appeal was called "Maximus." The third appeal overturned the denial saying that the procedure is not investigative.

Did you hire Maximus?
Posted 6/11/2013 2:06 AM (GMT 0)
Nope, they're just who handles external health insurance appeals in Minnesota.
Posted 6/12/2013 2:58 AM (GMT 0)
FYI, Blue Cross/Blue Shield of Illinois paid for my procedure, including the linx device. All I paid was the co-pays and regular deductibles for my policy. They are really varying state by state, but keep fighting, because they've got state precedents in their own organization for approving and financing the procedure. I had my surgery March 12.
Posted 6/25/2013 2:09 AM (GMT 0)
Maximus apparently handles appeals in New Jersey as well.
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