Hello again/ Anthem BCBS info? - Vascular Birthmarks Foundation Forum
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  #1  
Old 08-27-2010, 12:30 AM
LizH LizH is offline
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Default Hello again/ Anthem BCBS info?

Hello again to everyone!

I'm 24, have had many laser treatments on my pws that spreads from my right hand up my arm and to my back.
While the most recent treatments I had in late 2009/early 2010 with a Perfecta were very effective in reducing the size of my pws, over the past few months I've had a few bumps that began to bleed form and I want to begin treatments again.

I just relocated to Virginia and now have insurance through Anthem BCBS of Virginia. Does anyone have experience in Virginia, or with Anthem, getting laser treatments covered?

Thanks in advance for any info!!
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Old 08-27-2010, 11:32 AM
missy missy is offline
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Which area of Virginia? I know there is a group in the Norfolk area, but if you are closer to DC, it would be helpful to look in Md.

As to getting it covered, ask Basia, our insurance expert:

http://birthmark.org/experts.php

Missy
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Old 08-27-2010, 02:15 PM
LizH LizH is offline
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I'm nearest to Richmond, VA which has a large number of dermatologists.

I could easily stay in northern VA though, does MD mandate treatment?
When I was very young I was treated in Maryland, but the cost per treatment went well over a thousand dollars (I was put under general anesthesia and an older laser was used) so I hadn't thought of going back.
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Old 08-27-2010, 09:24 PM
missy missy is offline
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If you're closer to southern Virginia, try contacting these:

http://birthmark.org/node/47#virginia



Missy
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  #5  
Old 09-23-2010, 10:41 PM
kelmel kelmel is offline
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I also have Anthem Blue Cross. They have covered my son's treatments without any problems. I worked with the surgery coordinator in my dermatologist's office to gather enough information, including pictures, for our doctor to deem the procedure to be medically necessary, not just cosmetic. Talk with the insurance claims person in your doctor's office to see what their procedure is for the initial submission to the insurance company. We filed all of our paperwork prior to the first surgery and have not had to do anything with Anthem since.

Hope this helps.
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Old 09-24-2010, 05:07 PM
nickbar nickbar is offline
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Yes, Anthem has covered laser frequently for cases. It is important that the doctor tx. establishes medical necessity. I would also recommend that when the doc. office calls to get pre-authorization, and if Anthem tells them pre-auth. is not required for out patient procedures to have the office request a pre determination/pre service review to establish medical necessity...that way you don't find out POST tx. that they did not consider it medically necessary. Typically Anthem sees the LASER code and automatically requires pre-authorization...but not all insurance co./plans do require this for out patient procedures. Good luck
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