LINX denied by insurance

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Robotaz
Regular Member


Date Joined Jun 2013
Total Posts : 32
   Posted 6/10/2013 9:35 AM (GMT -6)   
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

Ingy1968
New Member


Date Joined Apr 2013
Total Posts : 18
   Posted 6/10/2013 12:17 PM (GMT -6)   
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

dholmb
Regular Member


Date Joined Jul 2012
Total Posts : 23
   Posted 6/10/2013 4:18 PM (GMT -6)   
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.

Robotaz
Regular Member


Date Joined Jun 2013
Total Posts : 32
   Posted 6/10/2013 5:47 PM (GMT -6)   
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?

dholmb
Regular Member


Date Joined Jul 2012
Total Posts : 23
   Posted 6/10/2013 8:06 PM (GMT -6)   
Nope, they're just who handles external health insurance appeals in Minnesota.

sinfrontera
Regular Member


Date Joined Mar 2013
Total Posts : 89
   Posted 6/11/2013 8:58 PM (GMT -6)   
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.

Robotaz
Regular Member


Date Joined Jun 2013
Total Posts : 32
   Posted 6/24/2013 8:09 PM (GMT -6)   
Maximus apparently handles appeals in New Jersey as well.
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