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Subject:
From:
Elizabeth Kieschnick <[log in to unmask]>
Reply To:
Elizabeth Kieschnick <[log in to unmask]>
Date:
Tue, 5 Jun 2007 21:41:56 -0400
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<<Disclaimer: Verify this information before applying it to your situation.>>

Last August when my blood work tested positive for celiac, my gastroenterologist sent me for a bone density scan and an endoscopy.  I had the bone density scan the day before the endoscopy confirmed my celiac diagnosis. Fortunately, my bone density was fine. Unfortunately, Empire Blue Cross Blue Shield denied my claim for the bone density scan, stating, "Lacking a clinical history of increased risk for bone loss, the medical necessity of a bone density screening test in a 46-year-old individual is not established.  The medical records submitted do not indicate the medical reason for obtaining the test or that the results were used in treatment decisions. Therefore, the bone density study is not authorized for coverage."

My doctor sent my medical records to Blue Cross and they were reviewed, but my appeal was still denied. I now have 180 days to appeal the decision. Do any of you have advice for me regarding this appeal? (The scan cost over $500.) Are there any references to studies in medical journals that I can cite, supporting the screening of bone density in celiac patients?

I really appreciate any advice you can share with me.

Many thanks,

Elizabeth

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