Guest guest Posted August 24, 1999 Report Share Posted August 24, 1999 Hi Georgina, I'm happy to hear that Josh had not to much problems with his first injection of Methotrexate. Sammy hates any kind of needles and I just can not see, how we can drag her weekly to the injections or do this even ourself, if we have to face a big fuss. The monthly blood examinations are more than we can handle sometimes. She kicks and screams of top of her lungs and we have to hold her till it is over usually. So your informations has assured us, that this might be easier, than we think. Otherwise, I am reading through all your infos and would like to thank you for all the work you put into this. It help me to understand the disease and the seriousness of it, so much better! Solong for now, Regina gorgina <gmckin@...> >Reply- onelist > < onelist> >Subject: [ ] Insurance Coverage >Date: Mon, 23 Aug 1999 13:27:01 -1000 > ><< text1.html >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 1999 Report Share Posted August 25, 1999 <!doctype html public " -//w3c//dtd html 4.0 transitional//en " > <html> Hi Regina, <p>In the beginning, they used to monitor Josh's blood every week. Then, every two weeks. After about 6 months, they started doing it monthly. He never did kick and scream but he got very nervous beforehand. He always sat on my lap and held, no ... squeezed, my hand. It wasn't so much the pain from a drawing, just the thought of a needle going in and taking out his blood. He used to call the phlebotomists Vampires. He'd cry before the needle even went in. We had tried Emla cream and it did no good. It was more a psychological fear than a physical one. By the time the needle was in, he was already recovering. I've always told him, even though he's a boy :-) & nbsp; & nbsp; that crying is a way of expressing feelings. Maybe not the best way but an acceptable way. I told him if he felt better by crying, by all means do so, because it was necessary to get the blood work, no matter what. I've asked if it helps him in any way to cry. Used to be a release for him, of sorts, to let go of some of his frustration at having JRA. He said he doesn't want to cry about his arthritis everyday but sometimes he does so he picked when he was getting his blood work done. For the last two years or so, he hasn't cried during the procedures. Still, even weighing 67 pounds, he wants to sit on my lap, though. <p>I think he's also gotten a reward nearly every time he's had a blood test. He's filled an entire sticker book with stickers from the lab techs. and hospital people. That, or a band aid with cool designs on it. And we usually made a point of going out for lunch after a drawing, or at least getting an ice cream cone. Even though all the books say never offer children a food reward! I figure when I give blood, they always give me a snack afterwards. I think those things sort of helped along the way. <p>Actually, last week when he did the MTX injection, it was the first time he didn't sit on my lap. They had really nice, very comfortable reclining chairs lined up and he sat in one of those. I guess it gets somewhat easier as they get older. I think Helge's daughter had a fear of needles, also. I wonder if that has been solved? <p>Well, I hope is feeling well for now. <br>Take care, <br>Georgina</html> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 31, 2002 Report Share Posted August 31, 2002 Tami, I wanted to wish you luck battling your insurance company. Hopefully someone else out there has appealed them and won, and are willing to share their experiences. Be sure to go to our files section and look under the 'Help Folder' for tips and sample appeal letters. You can also find helpful information at http://www.plagiocephaly.org/support/insurance.htm Good luck to you, please keep us posted! Niki Kaylie & Danny (STAR grads) Phila., PA > Hi all: > Well, I am still battling with Blue Shield of > California. We were successful in our appeal with the > medical group - Scripps Clinic, which got us a > preauthorization letter, but now we are going through > the run around from Blue Shield (3 months of delays). > It is currently in their medical review department for > a medical necessity review, which they estimate will > take another 30-45 days. > > Anyone out there have any experience with Blue Shield > of California? I am ready for a fight, but still > keeping my fingers crossed. > > Thanks, > Tami, mom to Annika (DOC Grad 8/14/02) > > __________________________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 31, 2002 Report Share Posted August 31, 2002 Thanks Niki - I will check out the files section. Tami --- niki_jay175 <niki_jay175@...> wrote: > Tami, > > I wanted to wish you luck battling your insurance > company. Hopefully > someone else out there has appealed them and won, > and are willing to > share their experiences. Be sure to go to our files > section and look > under the 'Help Folder' for tips and sample appeal > letters. You can > also find helpful information at > http://www.plagiocephaly.org/support/insurance.htm > > Good luck to you, please keep us posted! > > Niki > Kaylie & Danny (STAR grads) > Phila., PA > > > > Hi all: > > Well, I am still battling with Blue Shield of > > California. We were successful in our appeal with > the > > medical group - Scripps Clinic, which got us a > > preauthorization letter, but now we are going > through > > the run around from Blue Shield (3 months of > delays). > > It is currently in their medical review department > for > > a medical necessity review, which they estimate > will > > take another 30-45 days. > > > > Anyone out there have any experience with Blue > Shield > > of California? I am ready for a fight, but still > > keeping my fingers crossed. > > > > Thanks, > > Tami, mom to Annika (DOC Grad 8/14/02) > > > > __________________________________________________ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 15, 2003 Report Share Posted June 15, 2003 Hi ... I think that would depend on your specific insurance plan. You should be able to check your policy for information. You should also talk to your surgeon's insurance person who will be able to give you a relatively accurate estimate of what will and will not be covered by your plan. Regards, Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2004 Report Share Posted February 25, 2004 Kris, Sorry to say I had absolutely NO LUCK with Aetna at all. They have specifically excluded the MGB as " experimental " . I even tried to get my employer to help me with the appeal since they were self insured and got a big " NO " . I finally ended up taking a loan against my 401k. It was well worth it. I would do it again in a minute. Here is the Coverage policy from Aetna, you can share with your friend... http://www.aetna.com/cpb/data/CPBA0157.html G 4/7/03 - Dr R 230/ 155 / 130 insurance coverage Hi all, Sorry! It has been an extremely long time since I came on the boards. Too busy doing all the things that I couldn't do before surgery, I guess! I am doing great and would love to hear from my littermates! I have a question for any one. I was very blessed to have my surgery covered in full with Ameraplan of MI, and I have a dear friend who is desperately in need of and wants to have the MGB (I just was showing her the site and had her sign up on the pre op boards). She has Aetna HMO of MI. Does anyone know if this plan has covered any or all of the procedure? Thanks for your help. Hope all are doing great! God Bless, Kris in MI Dr. R. April 30, 2003 350/217 and still losing! ---------------------------------------------------------------------------- -- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 16, 2004 Report Share Posted March 16, 2004 Subject: insurance coverage Hi Since many of our kids also have sensory intergration dysfunction this question is directed at all of you. My insurance is denying claims for OT therapy stating they have reviewed the requested progress notes provided byt the OT but certain criteria has not been met. I believe the criteria thaey are looking for is a letter of medical necessity from the ordering physician stating why OT is needed to RESTORE previous function lost. I know how to work this up for speech therapy since my son did in fact have jaundice and chronic ear infections from 10mo to 3 yo( I use the ear infection part) put how would I use this to get OT covered. Or is there another angle I am not thinking of. I was thinking maybe since he had so many ear infections he has problems in his vestibular system. Any thoughts on this. Also recently we took him to an ENT that recommends his adenoids come out..he just had strep again 4th time this winter. Could this have affected anything in his developement. Thanks for all your help Ann in Chgo mom to 9yo Global apraxia DSI and hypotonia Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 17, 2004 Report Share Posted March 17, 2004 Hi, Our OT put coordination problem for OT approval, so far it seems to have gone thru, my son has balnace problem, so it fit under coordination issue.However he had two febrile seizures last summer, so that maybe why they approved, although his problems were there prior to seizures, but at least now they can't balk about covering it. Colleen Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 1, 2004 Report Share Posted November 1, 2004 Hi Maggie: > memorial sloan kettering is even worse when it comes to this. it makes me so > mad to see their commercials after experiencing their billing department. if > you don't have blue cross, medicare or access to unlimited funds, be prepared > to be turned away by them. ==>Sloan Kettering is supposed to be one of the top hospitals in the country. Oh, shame on them for turning away the needy! I just got dumped by my oncologist and left out in the cold in the middle of ongoing chemo treatment because Medicare doesn't reimburse him enough. And it's just getting worse out there kids........ ~Amber Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 9, 2005 Report Share Posted January 9, 2005 Dear Arnold, Thank you Arnold, for the advice. I will take it!! Blessings to you!! Joanie > Hi Joanie & list, > Put in a claim and if it is denied try to involve your local elected > representatives. They usually hav social work staff that would love to get a chance > to work on a case for you. > If you are not covered they can inroduce a bill to force coverage. > arnold > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 13, 2005 Report Share Posted June 13, 2005 Hi, I don't have any experience with UHC, but I did want to point you in the direction of our insurance help section in our files section. There is a ton of stuff in there including sample letters that were successful. Hopefully someone w/UHC will chime in though. Good luck with your appeal. , mom to Hannah, DOCgrad Cape Cod, Ma http://hannahsnoggin.typepad.com --- In Plagiocephaly , " billsiegel1201 " <bsiegel@c...> wrote: > I am having trouble obtaining insurance coverage from United > Healthcare because they claim my daughter's " helmet " is cosmetic. I > guess you could say it is but there are other issues involved if we > did not proceed. She is wearing the helmet but I believe the > carrier's reasons are short sighted and need advice as to how to > proceed with the appeal process. Does anyone, who has successfully > appealed, preferably with United HealthCare, have any letters with > suggested terminology. Thanks. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 13, 2005 Report Share Posted June 13, 2005 Hi, I don't have any experience with UHC, but I did want to point you in the direction of our insurance help section in our files section. There is a ton of stuff in there including sample letters that were successful. Hopefully someone w/UHC will chime in though. Good luck with your appeal. , mom to Hannah, DOCgrad Cape Cod, Ma http://hannahsnoggin.typepad.com --- In Plagiocephaly , " billsiegel1201 " <bsiegel@c...> wrote: > I am having trouble obtaining insurance coverage from United > Healthcare because they claim my daughter's " helmet " is cosmetic. I > guess you could say it is but there are other issues involved if we > did not proceed. She is wearing the helmet but I believe the > carrier's reasons are short sighted and need advice as to how to > proceed with the appeal process. Does anyone, who has successfully > appealed, preferably with United HealthCare, have any letters with > suggested terminology. Thanks. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 10, 2006 Report Share Posted March 10, 2006 Hi, You are in a situation that many women find themselves in. Hardly anyone has ever planned for the expense of implant removal, and as so many women find themselves sick, have not been able to work to save up for it either. It is a very difficult situation to be in. Women have learned to be creative with financing, tapping into home equity, borrowing from family or friends, hitting retirement accounts, maxing out credit cards, or whatever it takes to get this paid for. Insurance coverage is possible. It does take the cooperation of your explanting surgeon. My insurance paid for my removal, and I credit my explanting surgeon with being helpful in the way he worded my letter requesting explant. Having Baker IV contractures will almost certainly help....it sounds like you have that with the hardening you describe, and so you should not have any problems as long as your surgeon stresses that. Some PS's are not willing to deal with insurance at all, and so you might have to put out the cash and then ask for reimbursement. Where are you located? Dr. Kolb in Atlanta Georgia is very good at working with insurance to get them to pay for removal. Her website is www.plastikos.com Patty > > Hi > I've had saline implants for 10 years. I've wanted to have them > removed but haven't been able to afford it. I have severe hardening > and many other problems with them. > Eight years ago my health insurance wouldn't pay for it. I wanted to > know if any of you have been able to have insurance cover removing the > implants and could offer me any advice. > Thanks > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 10, 2006 Report Share Posted March 10, 2006 Welcome to ! . . . I'd check with your insurance again. Most insurance companies know they save money by removing implants, rather than allow someone to get sicker by the day. Contracture is often accepted as a reason. The main thing you need to be concerned about is that your surgeon will remove your implants " en bloc " , or if en bloc is not possible, removes ALL the capsule. A good surgeon will also use drains as long as you have significant drainage. Most docs would like to do a quick and easy (for them) removal - leaving the capsules behind with all the contamination they hold. Hugs and prayers, Rogene Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 11, 2006 Report Share Posted March 11, 2006 I'm in New York city. The PS I saw 8 years ago wanted $14,000 to remove the implants and scar tissue. I don't have any cash or assets or family to help me. Two or 3 years after I got the implants I became depressed and over the next few years my depression spiraled out of control to where I wasn't able to work. I sold my condo in California along with everything else I owned, cashed in retirement accounts, ended up declaring bankruptcy and was actually homeless for a short time. I'm not saying my depression was all because of the implants, I went through a series of devasting events that all contributed. I'm still getting my life back together 10 years later. My left breast is extremely hard, so hard that I avoid hugging or getting close to any person. Both breasts have increased in size. After surgery I was a C cup, my left breast is now an E cup and my right is probably a D or DD. They're frequently painful and seem to itch inside. I'm very self conscious, I never wear anything fitted or that klings because they are so obvious, in fact I slouch to try to disguise the abnormal shape and I carry my bag in front of me to cover up. I recently learned of a cosmetic surgery residency program that charges a flat fee of $2500. They were going to remove the implants but not the scar tissue. I got on the waiting list in September 2005, and managed to save the money. I was scheduled for the surgery for March 21st. About 2 weeks ago I discovered a lump on my left breast, I had an MRI and sonogram last week. They don't think it's cancer but want me to come back for a biopsy. So I'm sure that'll mean I lose my surgery date. I still can't afford to pay the regular fee. I'm desperate to get these removed. > > Hi, > You are in a situation that many women find themselves in. Hardly > anyone has ever planned for the expense of implant removal, and as so > many women find themselves sick, have not been able to work to save up > for it either. It is a very difficult situation to be in. > > Women have learned to be creative with financing, tapping into home > equity, borrowing from family or friends, hitting retirement accounts, > maxing out credit cards, or whatever it takes to get this paid for. > > Insurance coverage is possible. It does take the cooperation of your > explanting surgeon. My insurance paid for my removal, and I credit my > explanting surgeon with being helpful in the way he worded my letter > requesting explant. Having Baker IV contractures will almost > certainly help....it sounds like you have that with the hardening you > describe, and so you should not have any problems as long as your > surgeon stresses that. Some PS's are not willing to deal with > insurance at all, and so you might have to put out the cash and then > ask for reimbursement. > > Where are you located? Dr. Kolb in Atlanta Georgia is very good > at working with insurance to get them to pay for removal. > Her website is www.plastikos.com > Patty > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 11, 2006 Report Share Posted March 11, 2006 Welcome, I had saline implants for six years and have lost alot in the past year due to my illness. I had my implants taken out by Dr. Feng in Ohio. I drove 6 hours and paid for hotel for 6 days. Her cost for a en-bloc procedure was $6650.00. I did not need a lift, but if you feel you do, you can always do one at another time. Make sure you get a total capsulectomy. The pathologist found silicone in my scar tissue. I am so glad that was never left inside, or I may not ever get better. Feel free to ask any question here, there is a wonderful group of Ladies here to help. Hugs, jsei246 <jsei246@...> wrote: I'm in New York city. The PS I saw 8 years ago wanted $14,000 toremove the implants and scar tissue. I don't have any cash or assetsor family to help me. Two or 3 years after I got the implants Ibecame depressed and over the next few years my depression spiraledout of control to where I wasn't able to work. I sold my condo inCalifornia along with everything else I owned, cashed in retirementaccounts, ended up declaring bankruptcy and was actually homeless fora short time. I'm not saying my depression was all because of theimplants, I went through a series of devasting events that allcontributed. I'm still getting my life back together 10 years later.My left breast is extremely hard, so hard that I avoid hugging orgetting close to any person. Both breasts have increased in size. After surgery I was a C cup, my left breast is now an E cup and myright is probably a D or DD. They're frequently painful and seem toitch inside. I'm very self conscious, I never wear anything fitted orthat klings because they are so obvious, in fact I slouch to tryto disguise the abnormal shape and I carry my bag in front of me tocover up.I recently learned of a cosmetic surgery residency program thatcharges a flat fee of $2500. They were going to remove the implantsbut not the scar tissue. I got on the waiting list in September 2005,and managed to save the money. I was scheduled for the surgery forMarch 21st. About 2 weeks ago I discovered a lump on my left breast,I had an MRI and sonogram last week. They don't think it's cancer butwant me to come back for a biopsy. So I'm sure that'll mean I losemy surgery date. I still can't afford to pay the regular fee. I'm desperate to get these removed. >> Hi,> You are in a situation that many women find themselves in. Hardly > anyone has ever planned for the expense of implant removal, and as so > many women find themselves sick, have not been able to work to save up > for it either. It is a very difficult situation to be in. > > Women have learned to be creative with financing, tapping into home > equity, borrowing from family or friends, hitting retirement accounts, > maxing out credit cards, or whatever it takes to get this paid for.> > Insurance coverage is possible. It does take the cooperation of your > explanting surgeon. My insurance paid for my removal, and I credit my > explanting surgeon with being helpful in the way he worded my letter > requesting explant. Having Baker IV contractures will almost > certainly help....it sounds like you have that with the hardening you > describe, and so you should not have any problems as long as your > surgeon stresses that. Some PS's are not willing to deal with > insurance at all, and so you might have to put out the cash and then > ask for reimbursement.> > Where are you located? Dr. Kolb in Atlanta Georgia is very good > at working with insurance to get them to pay for removal.> Her website is www.plastikos.com> Patty > > Relax. virus scanning helps detect nasty viruses! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 11, 2006 Report Share Posted March 11, 2006 , have you noticed that all the 6's in your story? Six years with implants, 6 hours to have them out, a six day stay afterwards, paid in the 6 thousands to have them out, and of course the year you had them out was 2006. Maybe six is your lucky number!! Sis > > > > Hi, > > You are in a situation that many women find themselves in. Hardly > > anyone has ever planned for the expense of implant removal, and as so > > many women find themselves sick, have not been able to work to save up > > for it either. It is a very difficult situation to be in. > > > > Women have learned to be creative with financing, tapping into home > > equity, borrowing from family or friends, hitting retirement accounts, > > maxing out credit cards, or whatever it takes to get this paid for. > > > > Insurance coverage is possible. It does take the cooperation of your > > explanting surgeon. My insurance paid for my removal, and I credit my > > explanting surgeon with being helpful in the way he worded my letter > > requesting explant. Having Baker IV contractures will almost > > certainly help....it sounds like you have that with the hardening you > > describe, and so you should not have any problems as long as your > > surgeon stresses that. Some PS's are not willing to deal with > > insurance at all, and so you might have to put out the cash and then > > ask for reimbursement. > > > > Where are you located? Dr. Kolb in Atlanta Georgia is very good > > at working with insurance to get them to pay for removal. > > Her website is www.plastikos.com > > Patty > > > > > > > > > > Opinions expressed are NOT meant to take the place of advice given by licensed health care professionals. Consult your physician or licensed health care professional before commencing any medical treatment. > > " Do not let either the medical authorities or the politicians mislead you. Find out what the facts are, and make your own decisions about how to live a happy life and how to work for a better world. " - Linus ing, two-time Nobel Prize Winner (1954, Chemistry; 1963, Peace) > > See our photos website! Enter " implants " for access at this link: > http://.shutterfly.com/action/ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 11, 2006 Report Share Posted March 11, 2006 Jessi (OK to call you that?) Welcome to . . . I'm glad you found us before getting your implants removed! It makes me sick whenever I see another woman who has lost everything to her implants! . . . We see it over and over! Still, they keep implanting women! Crazy! Those who know what's going on apparently are helpless to stop it! It's very important to remove the capsule along with the implant. When a woman is symptomatic, or the capsules are hard, they contain debris from the implants and organisms that will continue to make you sick! When implants are properly removed (en bloc), they cut around the capsule and remove it with the implant still inside to avoid spilling contaminated materials into the chest cavity. A good doctor will also use drains to avoid fluid buildup causing pain and possible further surgery. Are you on Medicad? They may help you have them removed. We have several recommended doctors in New York - I don't know what they charge though! It's a shame that women aren't told before they get implants, that they need to establish a fund for maintaining/explanting! . . . As one plastic surgeon told me, to my face, that he make money putting them in and he made money taking them out. He didn't give a %^ & * what the women did! Hugs and prayers, Rogene Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 30, 2006 Report Share Posted March 30, 2006 --- kathy svetlik <ksvetlik@...> wrote: > Has anyone received coverage for their helmet after > appeals etc. even if the insurance contract excluded > cranial orthotics? > I am currently in my first appeal with my son's > StarBand. We appealed on the basis of medical > necessity. Plus does anyone know if you use the same > letters from the MD's that you used for the first > appeal for subsequent appeals? > Thanks. > Kathy > > --- shields31 <shields31@...> wrote: > > > Hi , > > > > Laurel is 7 months old now. Thanks for the > > clarification about the > > active/passive thing. She's only been in the > helmet > > for about 2.5 > > weeks now, so I'm still learning. She was > supposed > > to go in for an > > adjustment at 3 weeks and then monthly after that. > > > > I didn't really have any choice in the ortho > > department. He's the > > only one that does the cranial banding for > infants. > > He seems very > > knowledgeable though, and I've been pleased with > the > > adjustments. > > It's just so odd that Laurel would have the helmet > > on for almost a > > week and a half and then all of the sudden, it > seems > > too tight on > > one cheek. She had been sick, so I wonder if > there > > was some > > swelling or water retention involved? > > > > We go in this afternoon, so I'll post an update > > later... > > > > Thanks again, > > Kirsten > > Mom to Laurel - Hanger Helmet 3.15.06 > > > > > > > > > > > > Currently Laurel is out of her Hanger helmet, > > she has been VERY > > sick > > > > with an ear infection and was in and out of > her > > helmet over the > > > > weekend. When her fever would go up, we'd > take > > it off until it > > came > > > > back down. > > > > > > > > I noticed that she was getting a pretty bad > > indentation on her > > left > > > > cheek from the helmet, so I changed her next > > appointment from > > April > > > > 3rd to tomorrow. It seemed to go away, so I > put > > the helmet back > > on > > > > her. So last night I took it off for her bath > > and she had a BIG > > red > > > > mark on her cheek that didn't go away after an > > hour...in fact, > > most > > > > of the mark is still there this morning! I'm > > not putting the > > helmet > > > > back on now until it's adjusted, plus I > printed > > some pictures of > > > > what happened last night to show the ortho. > > It's definitely a > > red > > > > mark and not a rash. > > > > > > > > Anyway, I was doing a search of the boards to > > see if others had > > this > > > > problem and I ran across some info that said > > that Hanger Helmets > > > > were active ones and not passive? I was under > > the impression > > that > > > > it was a passive one and that her head was > > supposed to grow into > > > > it? Did I just not ask the appropriate > > questions of the ortho? > > > > > > > > With all the issues my girl has had since > > getting the helmet, > > I'm > > > > seriously doubting my decision to treat now. > In > > my head I know > > it > > > > will be for the best in the long run, but in > my > > heart I hate > > putting > > > > her through all of this. > > > > > > > > Thanks for any input, > > > > Kirsten > > > > Mom to Laurel - Hanger Helmet 3.15.06 > > > > > > > > > > > > > > > > > > > > > > > > > > __________________________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 30, 2006 Report Share Posted March 30, 2006 --- kathy svetlik <ksvetlik@...> wrote: > Has anyone received coverage for their helmet after > appeals etc. even if the insurance contract excluded > cranial orthotics? > I am currently in my first appeal with my son's > StarBand. We appealed on the basis of medical > necessity. Plus does anyone know if you use the same > letters from the MD's that you used for the first > appeal for subsequent appeals? > Thanks. > Kathy > > --- shields31 <shields31@...> wrote: > > > Hi , > > > > Laurel is 7 months old now. Thanks for the > > clarification about the > > active/passive thing. She's only been in the > helmet > > for about 2.5 > > weeks now, so I'm still learning. She was > supposed > > to go in for an > > adjustment at 3 weeks and then monthly after that. > > > > I didn't really have any choice in the ortho > > department. He's the > > only one that does the cranial banding for > infants. > > He seems very > > knowledgeable though, and I've been pleased with > the > > adjustments. > > It's just so odd that Laurel would have the helmet > > on for almost a > > week and a half and then all of the sudden, it > seems > > too tight on > > one cheek. She had been sick, so I wonder if > there > > was some > > swelling or water retention involved? > > > > We go in this afternoon, so I'll post an update > > later... > > > > Thanks again, > > Kirsten > > Mom to Laurel - Hanger Helmet 3.15.06 > > > > > > > > > > > > Currently Laurel is out of her Hanger helmet, > > she has been VERY > > sick > > > > with an ear infection and was in and out of > her > > helmet over the > > > > weekend. When her fever would go up, we'd > take > > it off until it > > came > > > > back down. > > > > > > > > I noticed that she was getting a pretty bad > > indentation on her > > left > > > > cheek from the helmet, so I changed her next > > appointment from > > April > > > > 3rd to tomorrow. It seemed to go away, so I > put > > the helmet back > > on > > > > her. So last night I took it off for her bath > > and she had a BIG > > red > > > > mark on her cheek that didn't go away after an > > hour...in fact, > > most > > > > of the mark is still there this morning! I'm > > not putting the > > helmet > > > > back on now until it's adjusted, plus I > printed > > some pictures of > > > > what happened last night to show the ortho. > > It's definitely a > > red > > > > mark and not a rash. > > > > > > > > Anyway, I was doing a search of the boards to > > see if others had > > this > > > > problem and I ran across some info that said > > that Hanger Helmets > > > > were active ones and not passive? I was under > > the impression > > that > > > > it was a passive one and that her head was > > supposed to grow into > > > > it? Did I just not ask the appropriate > > questions of the ortho? > > > > > > > > With all the issues my girl has had since > > getting the helmet, > > I'm > > > > seriously doubting my decision to treat now. > In > > my head I know > > it > > > > will be for the best in the long run, but in > my > > heart I hate > > putting > > > > her through all of this. > > > > > > > > Thanks for any input, > > > > Kirsten > > > > Mom to Laurel - Hanger Helmet 3.15.06 > > > > > > > > > > > > > > > > > > > > > > > > > > __________________________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 11, 2006 Report Share Posted April 11, 2006 Hi Molly, He has a book that he sells. Everything in his book can be found in our insurance folders here. Just wanted to let you know. -- In Plagiocephaly , " Foley, Molly " <mafoley@...> wrote: > > I just ran across this web page regarding fighting insurance companies that > won't cover cranial bands/helmets: > > http://www.plagiocoach.com/ > > Thought it might help those of you who are going through appeals with your > insurance companies. > > Take care, > Molly > California > Nicolas, 6 months, tort & plagio, getting STARband in April > , 3 > , 6 > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 11, 2006 Report Share Posted April 11, 2006 Thanks for clarifying that. Hopefully no one runs out to buy the book if all the information is in the files :>) I didn't read the website in detail since we are fortunate to have our insurance covering our band. Molly Re: insurance coverage Hi Molly, He has a book that he sells. Everything in his book can be found in our insurance folders here. Just wanted to let you know. -- In Plagiocephaly , " Foley, Molly " <mafoley@...> wrote: > > I just ran across this web page regarding fighting insurance companies that > won't cover cranial bands/helmets: > > http://www.plagiocoach.com/ > > Thought it might help those of you who are going through appeals with your > insurance companies. > > Take care, > Molly > California > Nicolas, 6 months, tort & plagio, getting STARband in April , 3 > , 6 > For more plagio info Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 11, 2006 Report Share Posted May 11, 2006 > I have Humana insurance. Last year, my son's psychologist had to put psychosis as diagnosis #1, and Aspergers as diagnosis #2. They would not cover him with Aspergers as #1. Still..........they only cover 20 visits a year.......should be more! > I have Blue Cross Blue Shield and they will not cover anything that > has to do with Autism. They wouldn't even cover for a psychologist to > see him. Autism is not a covered benefit on most insurances. I don't > understand why. Maybe this is something we need to get started to > fight these insurance companies. > > Cori > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 14, 2006 Report Share Posted May 14, 2006 I have BCBS as well, and they are covering everything for my Son, who has diagnosis of PDD,<which asperger's falls into) ADHD and BIPOLAR........they pay for Doctor's, psychiatrist's and counseling..........but you have to have it pre-authorized and your doctor or counselor is supposed to do that for you so they can get the full benefits....mine is paying very well. Lynda Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 14, 2006 Report Share Posted May 14, 2006 I have BCBS also and under our plan, since BCBS is only ADMINISTERING the plan, meaning the company we get our insurance from is Self-Insured and they wrote the plan, we've had services related to " treatment " for Autism covered. It's important to find out if the insurance company is Administering the Plan, or if they are the Underwriter. Another thing to consider is what type of plan you have and if there are any exclusions. PPO, POS, HMO??? These all make a difference in how insurance companies will pay for services. For example, if you have to get pre-authorization to go to a psychologist, then make the phone call. YES, when it comes to dealing with insurance, it's a HUGE pain in the rear...but you do need to follow the rules. Check your area to see if there is a non-profit agency that will help you get your insurance to pay for services. It's also very possible that the problem is in the coding of the bill. What I've found out is that almost all insurance companies will scrutinize over the first three codes in the billing and if " Autism " is coded in one of the first three, then that may be the problem. If all else fails, you may want to consider secondary insurance. > > I have Blue Cross Blue Shield and they will not cover anything that > has to do with Autism. They wouldn't even cover for a psychologist to > see him. Autism is not a covered benefit on most insurances. I don't > understand why. Maybe this is something we need to get started to > fight these insurance companies. > > Cori > Quote Link to comment Share on other sites More sharing options...
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