In October I posted my letter of appeal after Blue Cross Blue Shield’s told me it would not cover my bone marrow donor search. After hearing no response for several weeks I resent the letter certified and finally heard back. The verdict was…there was no verdict.

My appeal was not reviewed because I did not provide the necessary diagnosis/procedure codes. Below is my second response which includes the codes for Aplastic Anemia and Bone Marrow Transplant, both were provided by my doctor.

Empire Blue Cross Blue Shield                                               January 12, 2010

PO Box 1407
Church Street Station
New York, N.Y. 10008-1407

To Whom It May Concern:

This is the second letter I’ve sent regarding the denial of coverage of my Bone Marrow donor search. I’ve included a copy of my previous correspondence, which I have sent twice—the first letter was sent on the 23rd of October, 2009. A second copy was sent certified on November 24, 2009, after I did not receive a response.

Per your request I am providing diagnosis codes, despite my previous letter which stated a diagnosis. To be clear, my disorder is Aplastic Anemia of the most severe form. The ICD-9-CM for this disorder is 284.90, per the office of my hematologist, Dr. [name removed], M.D.  The cure for this disease is bone marrow transplant, ICD-9-CM 382.40, once again per the office of Dr.[name removed], M.D. Bone Marrow transplant cannot be performed until a suitable donor is found via a donor search.

Again, the diagnosis/ICD-9-CM for Aplastic Anemia and Bone Marrow Transplant are:
Aplastic Anemia: 284.90
Bone Marrow Transplant: 382.40

Please expedite the approval of my Bone Marrow donor search, due to the nature of my disease time is of the essence.

Thank you, in advance, for your prompt attention to this most crucial matter.

Sincerely,

Matthew C. Sheehan

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