Appeal
Limecat, BC/BS refused to pay for my cellcept, even though I and my neuro supplied BC/BS with extracts from reputable journals showing that cellcept is a standard treatment for CIDP, especially as a substitute for prednisone which cannot be safely used for long periods.
Long story short, I was denied twice by BC/BS and was informed that I had the option of an external appeal through my state insurance commission. I went that route and BC/BS’s decision was REVERSED. Thus the insurance company has to reimburse me the $3,000+ out of pocket cost, less co-pays.
It takes awhile to get a decision and then your reimbursement (even the $25.00 filing fee was reimbursed), but it is worth it if you can foot the bill for 3 months or so. I’m no lawyer, but it sounds like you have a darn good case.
Good luck, Limecat.
Sharon
Appeal
No call from an attorney yet so I filed an appeal on my own. SS called and did want the information from where I had gone this week. I told the lady that I have no reflexes and the doc they sent me to barely checked only one spot. She also added the lymph edema and noted fatigue comes with that.
So it is with renewed hope that I post this! Thank you all for hanging in there with me 🙂