Dr Osborne- Blue Cross Blue Shield Out of Network Waiver-2025

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I know insurance limitations that make this entire process even more difficult. I was fortunate to receive care with Dr. Osborne on the 25th and 30th. Though he was considered out of network there are “Waivers” that can be requested. Through my husbands diligent efforts, we were surprisingly approved. BCBS will now pay for the surgery with in network benefits ( there may still be out of pocket costs) because of 1) the rarity of this conditions 2) having no other specialist within 150 miles, 3) having no other specialist who can treat you within reasonable time frame. Every insurance is different but I hope this can help. Attached is a copy of the letters and documentations sent.
BCBS Waiver.pdf (3.5 MB)

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Thank you for sharing this information!

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Thank you! Well done to your husband pushing for your surgery funding!

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Is this in Canada?

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No, in the U.S. but you might be able to use the same idea in Canada to make an appeal when you can’t get care for a rare disease or syndrome. BCBS stands for Blue Cross/Blue Shield which are two prominent medical insurance companies in the US that seem to have recently merged or are now working together.

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Oh wow! I have BCBS and they arent wanting to cover Dr Hepworth in Denver because it’s out of network . Thank you so much for sharing this🙏

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Would you suggest to download this waiver and put my own info and Dr info? Then send to BCBS?

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Or would I request a waiver from my BCBS case manager? Sorry for all the messages. I’m on a tight time crunch. Surgery date for right styloidectomy and jugular decompression is August 18th :folded_hands:

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My husband called the customer service number and was transferred to prior auth. On the phone he initiated the waiver. We would advised this because its recorded and they have 5 days to make a decision so it starts the process. They will collect the needed info like the NPI numbers and fax numbers to dr and surgical facility along with diagnosis and procedure codes. They will also need the dates of the surgery and how many follow ups will be needed. Once the requests are completed you will get a case number, 1 for the doctor and the other for the facility. They will fax along the conformation number and made us submit our write up. The write up was shown, we also included imagining and a basic letter from from the doctor that they should have. ( show your doctor the copy of Osborne if they don’t have one). Make sure to make a note in your write up how “rare” the condition is. Recall the 5 day turn around, day 2/3 call again. “Just calling to make sure you got it”, stress the dates of surgery and ask if it can be " expedited" The more you follow up, the more notes, the more sense of urgency. This documentation will be reviewed by a nurse practitioner. FIGHT FIGHT FIGHT! Insurance works for us, shame its gotten to this point.

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I just burst into tears. These are very detailed step by step instructions. I have already started the write up thanks to you.:folded_hands: and chatgpt of course. It helped me put it into my own words and all of my tests and what not. I truly appreciate you posting this, it will definitely help people, it already has. :pink_heart: I will call them tomorrow. I have already been sending letters from doctors that arent qualified that the insurance wanted me to send referrals too so this will help so much on top of those letters. How are you feeling after your bilateral surgery?