My doctor faxed a Letter of Medical Necessity but Blue Cross Blue Shield says they don’t have it, they do have it but it’s Pharmacy, they do have it but it’s Medical, it’s processing, it’s not processing, and it was never received. What can I do?
My doctor faxed a Letter of Medical Necessity asking Blue Cross Blue Shield (I have a good PPO plan through my employer) to cover an electrolyte and sodium product (Normalyte) that I take 3x a day for a condition called POTS. It helps reduce symptoms like tachycardia to the 160s, debilitating fatigue, and syncopal episodes. It’s only $60-80 a month, which is a lot for me but not a lot for an insurance company. It also saves them money by reducing the amount I’d go to urgent care, ER, or my cardiologist and potentially need expensive medications later. The letter explains my medical condition, the product, and why it’s medically necessary.
My doctor submitted it almost 2 months ago but every time I call BCBS, I get a different answer. First, the agent confirmed they received the letter but said they didn’t know who was processing it. Next, an agent said they didn’t receive the letter and are not going to look for it. Next, the agent said they received the letter but it was just “processing” and they would be getting back to the doctor soon with the decision. Weeks later, I heard nothing and called again, and once again this agent said they don’t know what letter I’m talking about and there’s nothing in the system. Somebody told me to fax it again, so my doctor faxed it again, and the same result. Medical always tells me “no it’s Pharmacy” and Pharmacy always tells me “no it’s Medical”.
At one point, Pharmacy said they probably wouldn’t cover it because they offer IV fluids as an alternative. I tried to explain that it’s not an alternative, I don’t need to shoot up my veins for nothing, and IV fluids on a weekly or even daily basis like some POTS patients get is WAY more expensive for them so they shouldn’t want me to get that done anyway. No dice.
I understand that everybody’s overwhelmed and this is above agents’ paygrade, but how can I get help with this? Is there anyone else I can reach out to?
