Wiki Esi denials help please

[amandapsps]

Can anyone give some advise of what documnetation you are sending if any to get paid on ESI's. We are in FL in BCBS is denying them for lack of medical necessity. If they are PPO or POS are you getting them Pre- Auth?

Thank you so much!

 

[dwaldman]

I am not in your location but saw someone else stating that they called BCBS in this region and they confirmed there was a system error between some certain dates. Might want to call if you are In-network, they will probably be able to relay this information to you over the phone. Failed conserative therapy, pain radiating down the arms or legs, radiculopathy confirmed by EMG, Current MRI report results, disruption in ADLs might be indications in their medical policy.