I am so frustrated with BCBS and Mayo. I have found out it is all about the code being correct to have things paid - doesn't matter how medically necessary the procedure is! Plus once coded it is very hard to get it changed.... Something about they want perfect audits and to change codes looks bad is my impression, so we suffer. I am starting to wonder if an attorney would help. Love the Mayo for their Dr's and medical service but dealing with the coding dept who you can never meet with face to face is a different story. I have learnt procedures can be coded in many different ways and it only matters to BCBS what the code is and if it is a covered one in your contract - they don't consider the "big picture" and decide to pay it. Everyone is very nice to talk with, shares empathy and suggestions for what the other side needs to do but bottom line is I get no where!!!

Example - the Radiation cone locator to hold Emmett's tongue in place while getting rads is not covered, ($2,000.00) let alone the floride trays. How could he have treatment without it? Social Worker visits - not covered. Physical therapy - even though he had 4 months of therapy covered earlier in the year after 1st surgery - this time, not covered. Nutritionalist visit to teach how to use the feeding tube when leaving the hospital - not covered. HPV test denied. All the pre-surgery testing denied. It is just crazy!!!!!! And the list goes on. Two of our Dr.s have written letters of medical necessity to no avail.

So frustrating. Have others had the same problem? Any suggestions on how to successfully deal with this problem? Thanks. Karen