Posted 12/6/2017 10:12 AM (GMT -7)
Hi Susie and thanks.
Though it's FDA approved, Carefirst apparently considers it 'investigative' for her treatment (as opposed to 'experimental' I suppose) and they claim to not cover investigatory treatments. Everything but the installation of the device is covered 100% (already pre-authed, even though my plan doesn't require pre-auths).
The surgeon's office was gathering up the necessary information to make an appeal, and the surgeon is in the process of scheduling a meeting with reps from Carefirst to discuss these apparently ongoing issues, but, we made the decision to cover that specific part of the surgery out of pocket (about $1600) with the hopes it will get reimbursed to us at some point. But, it has to be submitted and denied before we can appeal it. At least if we get it in before year's end, we won't be immediately facing another yearly deductible for the new year, as we've already hit that maximum this year. Besides, she wants it over ASAP so she can hopefully get some relief. According to the doc, she'll be in and out, walking out of the facility under her own power. She'll have to take it easy for a couple weeks, but she'll be able to work from home (no driving allowed).
I don't know if it surprises me or not that Carefirst is the difficult provider here or not.
Thanks for the link. It looks to be informative!