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Re: [[IP] Re: Insurance Questions -- Michael]

> It goes on to say that the covered service must
> > be accepted as necessary and appropriate for the patient's condition and
> not
> > mainly for the convenience of the patient or physician.
> > 
> > So.... I take this to mean, that Blue Cross Blue Shield has physicans who
> > can make the determination whether the Durable Medical Equipment is
> > medically necessary regardless of what my own doctor says.  They claim to
> > have guidelines.  Hope that doesn't hurt my chances for approval, which I'm
> > still waiting for........

This is the gotcha for the insurance company. Your doctor IS a BS/BC 
doctor by virtue of being approved as an "in plan" physician. They 
have a lot of trouble arguing with 

   "it was prescribed by your contract physician"

particularly since they require a letter of medical necessity. That 
document + their contractual relation ship with the physician slam 
the door on them using this argument against you.

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