Hello all,
This might actually come in handy for some. I decided if I couldn't beat 'em, I'd join 'em. I got a job at Anthem BCBS of Maine.
Anyhow, for anyone having problems, take a look at your certificate of coverage (CoC). That would be the documentation you got when you signed your benefit papers.
It will say whether or not the surgery is covered and any and all exclusions. If your CoC does not mention that you need 12 months of physician managed documentation, you can appeal on that alone. If it does not ask for any other testing or subject to testing limits or approval then you don't have to do it and you can scream bloody murder.
Trust me, they will drag their heels until you scream loud enough to get their attention. Go back and look at your CoC.
Erin
