My daughter is 7 years old. After 5 years of foamy, floating, suspicious looking stool, a positive fat malabsorption test, 3 significant episodes of GI bleeding, 3 colonoscopies with biopsies showing neutrophilic infiltration and lymphoid hyperplasia, as well as a strange lesion in her colon that doctors could not identify, my insurance company (Blue Shield of CA) turned down authorization for an Ambry Amplified genetic test. The basis for their decision was "no family history" and "negative sweat tests". (Sweat tests were 32/33...anyone who knows anything about CF knows that sometimes you can have negative results close to borderline and still have a problem!) I am not an expert, nor am I a doctor, so I by no means presume to know that she has CF on my own account, but why not rule it out so we can move on from here, or deal with it if need be? Hasn't she had enough puzzling symptoms to justify diagnostic testing? Sorry to vent; it's just been a long road...
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So frustrated...! Anybody had a similar experience? Advice?
- Thread starter jmom
- Start date
My daughter is 7 years old. After 5 years of foamy, floating, suspicious looking stool, a positive fat malabsorption test, 3 significant episodes of GI bleeding, 3 colonoscopies with biopsies showing neutrophilic infiltration and lymphoid hyperplasia, as well as a strange lesion in her colon that doctors could not identify, my insurance company (Blue Shield of CA) turned down authorization for an Ambry Amplified genetic test. The basis for their decision was "no family history" and "negative sweat tests". (Sweat tests were 32/33...anyone who knows anything about CF knows that sometimes you can have negative results close to borderline and still have a problem!) I am not an expert, nor am I a doctor, so I by no means presume to know that she has CF on my own account, but why not rule it out so we can move on from here, or deal with it if need be? Hasn't she had enough puzzling symptoms to justify diagnostic testing? Sorry to vent; it's just been a long road...
My daughter is 7 years old. After 5 years of foamy, floating, suspicious looking stool, a positive fat malabsorption test, 3 significant episodes of GI bleeding, 3 colonoscopies with biopsies showing neutrophilic infiltration and lymphoid hyperplasia, as well as a strange lesion in her colon that doctors could not identify, my insurance company (Blue Shield of CA) turned down authorization for an Ambry Amplified genetic test. The basis for their decision was "no family history" and "negative sweat tests". (Sweat tests were 32/33...anyone who knows anything about CF knows that sometimes you can have negative results close to borderline and still have a problem!) I am not an expert, nor am I a doctor, so I by no means presume to know that she has CF on my own account, but why not rule it out so we can move on from here, or deal with it if need be? Hasn't she had enough puzzling symptoms to justify diagnostic testing? Sorry to vent; it's just been a long road...
J
jrotier
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sent you a pm
J
jrotier
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sent you a pm
J
jrotier
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sent you a pm
I am so sorry you are going through this. I know that insurance companies usually say no for a lot of the more expensive testing, hoping that no one will challenge their decision. I spent hours and hours on the phone with my insurance company after my son was born. My insurance clearly stated that a child's newborn, 1 week, 1 month, etc. check-ups were covered, however they would not cover his newborn checkup because it took place in the hospital instead of a doctor's office???? I could not believe it. I spoke to a supervisor and was told to send in a formal appeal. I wish I had, but with a newborn and separating from my husband (now ex-husband), I just didn't have the energy. You definitely should not give up, you are absolutely right to in wanting to get the Ambry Amplified, you and your daughter both deserve a diagnosis, cf or not, and whatever treatment she needs. Sorry I'm not more help with the insurance issue, I just don't have any real experience battling the insurance companies. I'll see if my sister has any advice, she spent years and years fighting with her insurance company over claims. I wish you the best of luck and keep us posted.
I am so sorry you are going through this. I know that insurance companies usually say no for a lot of the more expensive testing, hoping that no one will challenge their decision. I spent hours and hours on the phone with my insurance company after my son was born. My insurance clearly stated that a child's newborn, 1 week, 1 month, etc. check-ups were covered, however they would not cover his newborn checkup because it took place in the hospital instead of a doctor's office???? I could not believe it. I spoke to a supervisor and was told to send in a formal appeal. I wish I had, but with a newborn and separating from my husband (now ex-husband), I just didn't have the energy. You definitely should not give up, you are absolutely right to in wanting to get the Ambry Amplified, you and your daughter both deserve a diagnosis, cf or not, and whatever treatment she needs. Sorry I'm not more help with the insurance issue, I just don't have any real experience battling the insurance companies. I'll see if my sister has any advice, she spent years and years fighting with her insurance company over claims. I wish you the best of luck and keep us posted.
I am so sorry you are going through this. I know that insurance companies usually say no for a lot of the more expensive testing, hoping that no one will challenge their decision. I spent hours and hours on the phone with my insurance company after my son was born. My insurance clearly stated that a child's newborn, 1 week, 1 month, etc. check-ups were covered, however they would not cover his newborn checkup because it took place in the hospital instead of a doctor's office???? I could not believe it. I spoke to a supervisor and was told to send in a formal appeal. I wish I had, but with a newborn and separating from my husband (now ex-husband), I just didn't have the energy. You definitely should not give up, you are absolutely right to in wanting to get the Ambry Amplified, you and your daughter both deserve a diagnosis, cf or not, and whatever treatment she needs. Sorry I'm not more help with the insurance issue, I just don't have any real experience battling the insurance companies. I'll see if my sister has any advice, she spent years and years fighting with her insurance company over claims. I wish you the best of luck and keep us posted.
Contact Beth Sufian. She can and will help you. I was reminded about Beth recently, by a good friend, in regards to a situation I am currently dealing with.
<a target=_blank class=ftalternatingbarlinklarge href="http://www.sufianpassamano.com/
">http://www.sufianpassamano.com/
</a>
Stacey
<a target=_blank class=ftalternatingbarlinklarge href="http://www.sufianpassamano.com/
">http://www.sufianpassamano.com/
</a>
Stacey
Contact Beth Sufian. She can and will help you. I was reminded about Beth recently, by a good friend, in regards to a situation I am currently dealing with.
<a target=_blank class=ftalternatingbarlinklarge href="http://www.sufianpassamano.com/
">http://www.sufianpassamano.com/
</a>
Stacey
<a target=_blank class=ftalternatingbarlinklarge href="http://www.sufianpassamano.com/
">http://www.sufianpassamano.com/
</a>
Stacey
Contact Beth Sufian. She can and will help you. I was reminded about Beth recently, by a good friend, in regards to a situation I am currently dealing with.
<br />
<br /><a target=_blank class=ftalternatingbarlinklarge href="http://www.sufianpassamano.com/
">http://www.sufianpassamano.com/
</a><br />
<br />Stacey
<br />
<br /><a target=_blank class=ftalternatingbarlinklarge href="http://www.sufianpassamano.com/
">http://www.sufianpassamano.com/
</a><br />
<br />Stacey
I work for an insurance company please place in writing that you want to appeal their decision. You have 180 days to do this per ERISA guidelines and they must respond with 45 days. You do not need any additional medical documentation however, you may want to have your physician submit a letter of concern.
I work for an insurance company please place in writing that you want to appeal their decision. You have 180 days to do this per ERISA guidelines and they must respond with 45 days. You do not need any additional medical documentation however, you may want to have your physician submit a letter of concern.
I work for an insurance company please place in writing that you want to appeal their decision. You have 180 days to do this per ERISA guidelines and they must respond with 45 days. You do not need any additional medical documentation however, you may want to have your physician submit a letter of concern.