Financial Assistance – Blue Cross Blue Shield

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  • #9258
    23years
    Participant

    Hello Everyone:

    As has often been the case, and shouldn’t be, but it’s reality, money makes the world ‘go round’. And as all of us are aware, the rising costs associated with health care, medical supplies, drugs from pharmaceutical companies, etc, do not bode well for women like us that just need SOME validation that this is a REAL medical condition and like all REAL medical conditions they warrant the attention of our medical insurance companies. Some women are not able to afford the treatment in New Hampshire with Dr Pacik because of the cost associated with the treatment. Mostly because women are either under-insured or their insurance companies state that Vaginismus and the use of Botox is “experimental” at best.

    Yes, insurance companies will pay for Botox for Migraines, Botox for Intersistial Cystitis (sp?), Botox for Torticollis (another severe form of muscle spasm in the body) and others. BUT vaginismus is still on the list of “unapproved” diagnoses for the use of Botox in most “fine print” of the insurance policies.

    However, that being said, and even though just this year Blue Cross Blue Shield updated their list of “unapproved” conditions for Botox (where Vaginismus was proudly displayed), something of a miracle has occurred. With the use of Diane, Dr Pacik’s medical billing specialist, and Dr Pacik’s well-constructed and thorough history/physical and operative notes submitted, Blue Cross Blue Shield came back and rendered a reimbursement to the patient.

    In my case, their reimbursement was over $3350 of the total therapies. That is over half of what the therapies cost. I will take that any day.

    While I still don’t agree that I should have “any” out of pocket costs for this treatment (nor should ANY woman with the Big V), less a co-pay perhaps, I am feeling more positive for other women undergoing the quest for reimbursement from their insurance companies. And if any woman gets a “no” – don’t take “no” for an answer. Appeal, and appeal again.

    It’s always puzzled me why insurance companies will pay for failed “approved” treatments. Such as physical therapy, medications, psychotherapy, EMG studies, hospitalizations, etc, which can total in the THOUSANDS and over a patient’s lifetime it can amount to HUNDREDS OF THOUSANDS of dollars they will have to pay for conditions related to the Big V but not the Big V treatment, the “cure” if you will for most of us – – BOTOX. Sad but true. And this is not the only condition insurance companies fail to pay for so we are not alone.

    But if all hope was lost in the finance department, here comes a piece of good news. Blue Cross Blue Shield of Connecticut has approved reimbursement of my claims to just over $3350. That, my friends, will be considered a Victory – – another BIG V for VICTORY this time and not Vaginismus.

    We win

    #13361
    mmHeather34
    Moderator

    This is absolutely wonderful 23yrs! Congratulations!!!

    #13362
    Kim
    Participant

    Amen!!

    #13363
    kelseroo
    Participant

    Wow, congratulations 23years! That is so great- even with working with Diane, my insurance wouldn’t reimburse me one cent:-/ I hope the policies of insurance companies changes soon with regards to these types of treatments!

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