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Why is Corneal Collagen Crosslinking (0402T) not covered by BCBSIL even though it is FDA approved and covered under other BCBS state plans?

Apparently this procedure is deemed "experimental" according to the BCBSIL agent I spoke to. It's been FDA approved since May 2016, and is covered by at least eight other BCBS plans,

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Would BCBSIL rather pay for a much more expensive corneal transplant instead? Why are other BCBS plans covering this and IL does not?

13 Replies

  • Hello, At this time procedure code 0402T is not eligible for coverage as explained by the person you spoke with on the phone. You do have the right to appeal this decision if you so wish. ~ Kayla
  • In reply to BCBSIL Connect Team:

    Thank you, Kayla. What is the process to appeal?
  • In reply to JonScruggs:

    You may contact the Blue Cross and Blue Shield of Illinois (BCBSIL) Claim Review Section, P.O. Box 2401, Chicago, Illinois 60690. If, after investigation, BCBSIL determines that the claim (or portion of a claim) was correctly denied, you may appeal the denial as detailed below.

    Under federal law, you are entitled to a full and fair review of the denied claim. Appeals must be made in writing within 180 days from the date you receive notice that your claim has been denied. You may submit written comments, documents, records and other information related to the claim for benefits with your appeal. You should also include any clinical documentation from your physician that would substantiate coverage of the denied claim.

    You will receive a written decision within 60 days of receipt of your appeal request.

    ~ Heather
  • In reply to BCBSIL Connect Team:

    Is this Corneal Crosslinking (epi off) still not covered by BCBSIL? I also need this procedure and have Blue Advantage.
  • In reply to TandSGib:

    If you could send us a private message I can have someone on our team check on this for you. ~ Heather
  • In reply to BCBSIL Connect Team:

    I would like to know the answer also. Is cross linking covered now? I've gotten different answers when I try calling the number on the back of my card. I have surgery on the 1st eye scheduled in a few weeks.
  • In reply to mylyndamoore:

    Hello, I'm responding to you on your private message. ~ Heather
  • In reply to BCBSIL Connect Team:

    I would like more info on this as well. It looks like Avedro's site is showing that it is covered but BCBSIL but my doctors office is telling me otherwise. Thank you!
  • In reply to LBrisbane:

    Hi, If you could send us a private message, we can check those benefits for you. ~ Heather
  • In reply to BCBSIL Connect Team:

    I keep seeing on various Keratoconus sites that BCBS/IL covers Corneal Collagen Cross Linking. Why is it that they are showing BCBS IL covers it if it is not a covered procedure? Better still, It is FDA approved for over 2 years now and has been shown to halt progression of this eye disease so why wouldn't it be covered? If in the early stages KC gets stopped it would save insurance companies a boatload of fees for specialty fittings for contact lenses which would be considered medically necessary. Also, in people with KC who are progressing if it gets halted it could spare them a more serious procedure like a corneal transplant. Not sure of the logistics of denying a procedure that could potentially save thousands of dollars.
  • In reply to Saniphelia:

    Hi Saniphelia, Corneal cross linking requires review to see if it is eligible for coverage under your health care plan. Your doctor can submit a predetermination of benefits request to see if coverage is available for this service under your plan. ~ Kayla
  • In reply to BCBSIL Connect Team:

    How do I find out if I specifically am covered? Can someone email or call me please?
  • In reply to Saniphelia:

    Hello, If you could send us a private message, we'd be happy to check on that for you. ~ Heather
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