Virginia Consumer Healthcare Alliance

Join today and support quality, consumer centered healthcare in Virginia.

From the Alliance

Insurance companies have too much red tape to negotiate an appeal on denial of coverage.

Recently, my general practitioner requested a lab sleep study for me back in Nov/Dec. I have had an individual policy with Anthem BCBS since being laid off from a catalog/retail company in 2009. The rhetoric for the Affordable Healthcare Act was to keep same coverage with same insurance company. My first request for a lab sleep study was turned down because it was not medically necessary for me. I don’t have any history of heart or lung problems. What I was doing was leaving work at 10 pm and dozing off driving home on a back country road with no cell service. The second request was for a home study — not as accurate, but still effective as a lab study. This request was turned down because the doctor was out of network and their was comparable service closer to my home. This determination is made by zip code. It does not take into consideration distance as the crow flies, traffic conditions and other circumstances. As the crow flies, Luray is closer to my home. My husband is comfortable driving there. He does not drive to Charlottesville which was the approved location. Luray is 27 miles from my home and we can drive to that location with encountering 1 traffic light. A UVA location at Pantops was approved. At least a 45 miles ride, with numerous traffic lights and much more traffic. I have yet to contest the decision because it takes forever to interpret the fine print for the appeal, and finding the time to have at least 20 minute wait times to make the appeal by phone! I have not appealed the decision and still need the recommended sleep study. I was licensed as a Life & Health Insurance agent and worked with Anthem BCBS on a daily business. If I am intimidated by the process, I can’t imagine other folks struggling with it without having that kind of background.