So this may or may not make sense but it sure doesn’t to me since I don’t even get my health insurance!
So I have had healthy blue North Carolina Medicaid for quite some time now. Little did I know upon finding a clinical UM guide online for healthy blue that they had updated requirements for a breast reduction procedure that were different from North Carolina Medicaid itself. Upon researching further into this I even called healthy blue and they confirmed that they sometimes cover breast reduction procedures, although the man on the phone did seem hesitant. (I understand just because they think that they cover the procedure doesn’t mean that they do, but he really didn’t go into that much detail as he seemed like he didn’t know too much himself.)
Well I just recently received my denial letter on the basis that I do not have any previous trauma, and it does not align with that guideline that I found online for healthy blue. I should note when I was 17 I did not have healthy blue because it was not a thing and I previously tried to have this procedure done when I just had NC Medicaid, and without looking at the policy. The doctor informed me of the reasons that I was just denied for today, that I would not qualify because Medicaid only covers it if you’ve basically had or have cancer.
However on healthy blues website independently, this is not what it says. Since healthy blue is basically like a branch of Medicaid, I was wondering why they are denying me solely on Medicaid instead of what healthy blue says, when in “the reasons supporting their decision” as it says on the letter they cite both healthy blue and NC Medicaid in the reason for their denial.
I’m not really sure if this is the right place to post this, but their office is closed for the day and it’s pretty upsetting to know I would have to pay out of pocket for a procedure that according to their guideline online it lists that I would be medically necessary for. I would have never pursued this again if I had known that this would be based off of Medicaid guidelines, and not healthy blues. Even though I am a healthy blue patient.
That link (if anyone feels like deep diving) is what I was basing this off of. I feel quite dumb now but what are ya gonna do. Thanks to those who read this far! Appreciate any advice.
submitted by /u/maggies101
[link] [comments]So this may or may not make sense but it sure doesn’t to me since I don’t even get my health insurance! So I have had healthy blue North Carolina Medicaid for quite some time now. Little did I know upon finding a clinical UM guide online for healthy blue that they had updated requirements for a breast reduction procedure that were different from North Carolina Medicaid itself. Upon researching further into this I even called healthy blue and they confirmed that they sometimes cover breast reduction procedures, although the man on the phone did seem hesitant. (I understand just because they think that they cover the procedure doesn’t mean that they do, but he really didn’t go into that much detail as he seemed like he didn’t know too much himself.) Well I just recently received my denial letter on the basis that I do not have any previous trauma, and it does not align with that guideline that I found online for healthy blue. I should note when I was 17 I did not have healthy blue because it was not a thing and I previously tried to have this procedure done when I just had NC Medicaid, and without looking at the policy. The doctor informed me of the reasons that I was just denied for today, that I would not qualify because Medicaid only covers it if you’ve basically had or have cancer. However on healthy blues website independently, this is not what it says. Since healthy blue is basically like a branch of Medicaid, I was wondering why they are denying me solely on Medicaid instead of what healthy blue says, when in “the reasons supporting their decision” as it says on the letter they cite both healthy blue and NC Medicaid in the reason for their denial. I’m not really sure if this is the right place to post this, but their office is closed for the day and it’s pretty upsetting to know I would have to pay out of pocket for a procedure that according to their guideline online it lists that I would be medically necessary for. I would have never pursued this again if I had known that this would be based off of Medicaid guidelines, and not healthy blues. Even though I am a healthy blue patient. That link (if anyone feels like deep diving) is what I was basing this off of. I feel quite dumb now but what are ya gonna do. Thanks to those who read this far! Appreciate any advice. https://provider.healthybluenc.com/dam/medpolicies/healthybluenc/active/guidelines/gl_pw_d073867.html submitted by /u/maggies101 [link] [comments]Read Morer/HealthInsurance