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    Created in 2008, Phoenix Rising is the largest and oldest forum dedicated to furthering the understanding of, and finding treatments for, complex chronic illnesses such as chronic fatigue syndrome (ME/CFS), fibromyalgia, long COVID, postural orthostatic tachycardia syndrome (POTS), mast cell activation syndrome (MCAS), and allied diseases.

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    Nexavir users: pls read -- need National Drug Code for FDA

    Here's a development. The defendants appealed the case I posted, and the Medicare Appeals Council (MAC) overturned it (i.e., ruled against Part D coverage for Nexavir). But you are not obligated to inform your Part D carrier or any appeal entity of this (let 'em do their own homework), and the...
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    Nexavir users: pls read -- need National Drug Code for FDA

    Attached is the case you're referring to. Best of luck.
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    Blue cross of new york refuses CFS diagnosis and treatment.

    But, interestingly, Social Security accepts EBV VCA and early antigen tests as diagnostic, and has done since 1999. From SSR-99-2p (Policy Interpretation Ruling Titles II and XVI: Evaluating Cases Involving Chronic Fatigue Syndrome): "Therefore, the following laboratory findings establish the...
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    Blue cross of new york refuses CFS diagnosis and treatment.

    For the claims Blue Cross has rejected, it rejected everything: visits, injections, oral drug administration, even venipuncture for blood draws (though BC paid Quest for the analyses). I'm particularly surprised about the office visits. The last three rejected claims were for simple monitoring...
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    Blue cross of new york refuses CFS diagnosis and treatment.

    I began treatment with Dr. Enlander in May 2008. From then until July 2009, Empire Blue Cross paid all claims. From 7/30/09 to 4/22/10 they rejected 19 of 38 claims claiming there were insufficient records to determine medical necessity; all 38 claims are identical, and the dates of rejected...