Recently my wife and I attempted to come up with a number of how many times I been in the hospital, both hospitalized and times I visited the ER since my gp was diagnosed. Along with that total we asked how many times have I been rushed to the hospital in an ambulance. The numbers where scary! We estimated that I was in the hospital 45-50 times since I had been diagnosed with gastroparesis six years ago. As for the ambulance rides, I counted eight or nine times. Ridiculous!
A few years ago, after my symptoms worsened my wife and I went to an appointment to see the gastroenterology department at Henry Ford Hospitals. We heard that of all the local hospital networks, Henry Ford Hospital was one of the leaders in doctors who knew about gp. In particular, we went to Henry Ford to see about getting a nuero-simulator for my stomach. I think anyone who suffers gp will agree that 20-60% of nausea relief some AWESOME! Thus we went to see the surgeon and I was happily told by the surgeon that I was a perfect candidate.
Then came the slap to my hope.
The surgeon told us that Blue Cross Blue Shield of Michigan (BCBS) will not pay for this surgery. According to BCBS the implant is still considered as "research" and as such they will not pay. My secondary insurance will help, but only if BCBS also pays. By the way the cost for this surgery is approximately $50,000.
For anyone who chooses to read my blog will find that I will often fall back to this issue with BCBS. Here's the question:
How many hospital visits and ambulance rides will they have to pay for until they see it would be cheaper and to give me the surgery?
What do you think?
Ugh. Just ugh.
ReplyDeleteAs a former BCBS employee, I would say to have your doctor ask them again, sending in your complete medical history along with proposed treatment plan. Unfortunately, BCBS will deny first time asked for "investigative research" But if the doctor can show cause as to the benefit of this for you, there are many times BCBS will make an exception. I wish the best of luck to you and hope you find some relief soon.
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