Allomax - Anthem BC/BS denied - Appeal?

Mommato3

I had a skin sparing mastectomy with immediate reconstruction last year. The PS used Allomax. Anthem states on their website that this product is considered experimental. The problem is that they denied the entire claim...anesthesia, pain meds, catheter, etc. They are telling me I'll need to appeal the claim for them to take a look at it. I just don't understand why they denied the entire claim instead of not paying the $425 charge. Has anyone had an experience with this? I don't know if I should concentrate on getting them to overturn paying the Allomax portion or just try to push for them to pay everything else. I'm really irritated that this happened. The PS office assured me the surgery was all approved. Well, apparently it was but the PS doesn't get approval for the products he uses in the surgery. How am I supposed to know what he's using while I'm out!?! Frustrating!!

WinningSoFar

I thought that it was the law that insurance companies have to pay for reconstruction. period. As far as allomax being experimental, Medicare pays for it (just had it myself), so I would question that it's experimental. Sounds to me like you are getting the run around.

Mommato3

Anthem states that they consider Allomax experimental. Who knows if that's true. What's frustrating is the fact that they denied the ENTIRE hospital bill over a $425 charge for the Allomax. Now I have to appeal to overturn the decision not to pay the rest. I'm not sure what Allomax has to do with anesthesia, pain meds, catheter, etc. They are required to pay for the mastectomy and reconstruction! I may need to speak to an attorney.