04/24/2024

BCBSM Carelon Authorization Letter Revised!

Dear MSHO Members,

Several of our members began reporting concerns from their patients when they received communication from Carelon informing them that their chemotherapy drug authorization has been dismissed.   

When chemotherapy drugs did not require an auth, Carelon sent dismissal notes to the patient letting them know that the drug auth has been dismissed, but not explaining to them that it was dismissed due to not needing an authorization.

This communication caused a lot of anxiety and confusion from our patients generating many calls to the practices because the patients misunderstood the letter and thought they were unable to receive their treatment. The patients did not understand why their drugs were being dismissed and feared their insurance would not cover them.

MSHO approached BCBSM and offered alterative language to the letter that would provide more clarification to the patient that they are eligible to receive their treatment, but that particular drug does not require an authorization.  

We are happy to report BCBSM has finalized the letter. There are now two distinct letters confirming the approved medications and those that are denied.  

Carelon Member Approval Letter

Carelon Member Denial Letter

This was a huge win for MSHO and we appreciate each of you reporting this to us so we could work together to resolve this issue.  

If you have any questions, please contact MSHO at billing@msho.org