Re: insurance question for you guys!

February 8, 2002

Kellie:

I don't want to get your hopes up, but it does sound to me like they

paid for his helmet! I get " Explanation of Benefits " from my health

insurance when they pay for a portion of any type of medical service

and/or prescriptions but don't pay the entire amount. So I would say

it sounds like they did pay for it, of course all ins. is different.

Give the hospital a call in the morning to see if they have rec'd

payment yet, that way you don't have to call the insurance company.

I hope they paid it!

How is doing in his helmet?

Debbie Abby's mom DOCgrad

MI

> Okay, here's the deal. We have Regence, and a couple months ago

received our

> denial letter from them. I have until the end of this month to

appeal the

> claim. I have been working on my appeal. However, at 's

appointment to

> receive his helmet, the nurse practitioner told me that someone had

just been

> finally approved through Regence Blueshield.

>

> Well, today, I got something from them in the mail, and it is one

of those

> forms that says, " Explanation of Benefits. This is not a bill. "

And below

> it is all the info about where the services were rendered,

Children's

> Hospital, and the date of Jan 17, 2002 matches up with the day he

received

> the helmet. Under services rendered, it says, " Misc Hospital

Services,

> billed $1300.00. Now, mind you, 1300 is the cost of the helmet!

However,

> there is an extra 200 bucks for their services like the adjustments

and stuff

> like that, but anyway, I read on further, and under " Allowed, " it

says

> $1235 " . Oh, and before I forget, there is an additional 30 dollar

charge for

> the chin strap, so, totaled onto the first amount, the total paid

amount is

> 1263! Am I going nuts or did Regence just pay for my son's

helmet? It's

> gotta be too good to be true, but I don't want to call them and

ask. I think

> I'll just leave things as they are and wait until I see something

that states

> something otherwise.

>

> Have any of you ever gotten anything like this from your insurance

companies?

>

> Kellie, Mom of , helmeted 1/17/02

> Tacoma, WA

February 8, 2002

,

I work in the medical field and it definatly seems to me that you're

helmet was paid for by your insurance. Call the insurance co.

tommorrow and make sure but things look good from my interpitation.

Maybe someone filed an appeal for you - ie the doctor or the clinic

that is doing the treatment. I know with our insurance appeals,

Leigha's surgeon, Cranial Tech, and me sent appeals in. Fingers

crossed for you and you can call you're clinic too and ask if they

recieved notice of coverage...they'll be one of the first to know if

they are getting payment ;O)!

Mel