Guest guest Posted February 13, 2002 Report Share Posted February 13, 2002 Hi all, successfully completed his six weeks of DOC Band treatment in January, and now the insurance company is refusing to pay. They had originally sent us a letter saying that they would cover it at 80% (out of network) but the letter also had the statement " This does not guarantee coverage " . Now we get a bill from CT, and the insurance only covered $68 dollars (!!!) of the band. They said they covered it like a rental of durable medical goods. How should we proceed to fight this? I'm so awful with dealing with insurance companies. We have Aetna PPO if that's any help. I looked over the files on the website, but I'm having trouble figuring out which direction to go. Thanks! Christi in TX Mommy to , 6/2/01 at 34 weeks, DOC Grad 01/02 http://www.exracers.com/nathan.htm Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 13, 2002 Report Share Posted February 13, 2002 Christi: Wow, your insurance company actually covered $68.00! How nice of them. (notice my sarcastic tone). I hope someone else can help you with your battle. I'm not too familiar with fighting, outside of never give up. What a bummer, especially after they had told you they'd cover it. Good luck. Debbie Abby's mom DOCGrad MI > Hi all, > > successfully completed his six weeks of DOC Band treatment in > January, and now the insurance company is refusing to pay. They had > originally sent us a letter saying that they would cover it at 80% > (out of network) but the letter also had the statement " This does not > guarantee coverage " . > > Now we get a bill from CT, and the insurance only covered $68 dollars > (!!!) of the band. They said they covered it like a rental of durable > medical goods. > > How should we proceed to fight this? I'm so awful with dealing with > insurance companies. We have Aetna PPO if that's any help. I looked > over the files on the website, but I'm having trouble figuring out > which direction to go. > > Thanks! > Christi in TX > Mommy to , 6/2/01 at 34 weeks, DOC Grad 01/02 > http://www.exracers.com/nathan.htm Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 13, 2002 Report Share Posted February 13, 2002 Christi, You need to ask your insurance company to send you the guidelines for filing an appeal. You can appeal their decision to cover only $68.00 of the band. It's possible that the appeal guidelines are included in your policy so check there too. Read the entire section on durable medical equipment in your policy and see if there seems to be any way to get around the $68.00 thing. That just doesn't seem right - I think your insurance company might have made a mistake. Give them a call and see what is going on! Marci (Mom to ) Oklahoma Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 14, 2002 Report Share Posted February 14, 2002 Wow Christi how frustrating-definitely et everything you can from your insurance company about their policy on DME equipment coverage and rental. I guess you could try and say if they covered it like a rental what did they base their rental cost on????? And generally rented equipment can be returned and used later-who can use your child DOC band? That is stupid! At any rate-see how the policy states-if they billed it like a rental I can guarantee there is something in your DME policy that reads that specialized equipment will be purchased. I am trying to remember the wording of when we used to get equipment covered when I worked in healthcare. Start there get as much info as you can about the DME and if they have anything in policy about helmet therapy-who is your insurance again?????? here are some insurance links in the meantime-also find out their appeals policy all steps and make sure you take them all. Beck Click here: Patient Advocate Foundation Welcomes You! Click here: State Insurance Departments Click here: Insurance Issues Click here: : Plagiocephaly Files Quote Link to comment Share on other sites More sharing options...
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