Re: Re: Mommy's trailblazing for Grant

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,

Way to go !!!! Your networking all over the place Good for you that

things are being sped up and taken very seriously! Let us know how the appt.

goes!

' Mom

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Thanks, ! I hope tomorrow isn't too bad. It took me a long time to have a healthy baby...like most Moms...I'd lay my life down for him.

rella1234@... wrote: ,Way to go !!!! Your networking all over the place Good for you that things are being sped up and taken very seriously! Let us know how the appt. goes!' MomFor more plagio info

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Good tip on documenting while talking with the insurance co. I'm calling them now...I'll let you know!

debbieandabby <dj2kirby@...> wrote: :WHOA, there's NO stopping you is there?? Way to go! I'm so happy that your ped. got the ball rolling so fast for you & Grant. Good luck with the skull series tests tomorrow (I'm not sure what that means either). I had to laugh at the "better product" comment you got from the other office! Hehe....geesh! Tough crowd isn't it? LOL.What insurance do you have? I called my ins. ahead of time to know where we'd be with their decision. It can't hurt to call to find out. Definitely document the names & times of who you talk to. Good luck with the tests tomorrow. We look forward to hearing the results.Debbie Abby's mom DOCgradMI> > Well, I'm making more progress. After our great appointment at Rehab Designs of America (CT), I left a message with my pediatrician that I did not want to wait for the specialist to get things going. I especially felt this way after I called the specialist's nurse to ask her some questions and as soon as she caught wind that I had brought Grant in for an evaluation at CT she seemed offended and put off. She said, "Well, we don't use the DOC band. We use a better product" about 5 times...pretty much in response to everything I said at that point. Ugh...I don't want this to be a brand competition...I just want to get my son taken care of ASAP. Anyway, I left the message with the ped asking if he could go ahead and order the tests to rule out Cranio and then consider writing the rx for the DOC band. I also told him I would still be glad to take Grant to the specialist appt in a few weeks, but I really wanted to start SOMETHING now. Grant's head is growing FAST. It measured 47 centimeters at CT yesterday (95 percentile!) and Bob at CT said that there are actually some orthotists that won't treat a skull once it measures 48+, because they assume the skull growth will be substantially slower from there on. But, we are hoping that since Grant's head has always measured large that it will continue along that growth rate. We are hoping. But, I just want to get things moving and not miss any more significant growth spurts. It frustrates me thinking how MUCH it has grown since we started asking, asking, asking our pediatrician about this. ANYWAY I got a call from a nurse at my ped's office today telling me to take Grant to Children's Mercy for a 'skull series' ? (CAT Skan? MRI? I'm not sure?) TOMORROW?! I asked her if he'd write the rx after the tests if they looked fine and she said she thought he was willing to go that route, but we'd talk with him after the tests come back. Halleluhah Question: Would it be a mistake for me to call my health insurance company and ask what their coverage is on DOC band therapy or should I wait and let CT do it if we go that route? I'm curious to know what we're in for, financially. > > Thanks!> > > , Mom to Grant (born 9/26/01)> > > --------------------------------->

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I did call yesterday and they would not straight out say if it was covered or not. They gave me what seems like the usual answer - please fax us a letter of medical necessity and Grant's medical history. When we get to that step, I'm going to make sure my ped has in his records the fact that we have been discussing Grant's neck tightness and head flattening since VERY early on. I remember asking about these things at this 1 month appt. GRRRRR...My policy has an orthotic exclusion, but they also say they cover things deemed reconstructive (the i.e. they gave was prosthetic for mastectomy or reconstructive surgery following mastectomy). I think if they'll cover breast implants following a mastectomy...they should cover this. Both are restoring a part of the body to a "normal" structure...right?! The DME coverage is 100%...but, who knows what they classify as reconstructive, what they classify as DME, what they classify as purely orthotic.

rmanias <rmanias@...> wrote: -I called before we got Dane casted to see if we were covered for the band. I was told about 7 or 8 times we were covered 80% with an out of pocket cap of $500. They have denied all of our appeals because of an orthotics exclusion in our policy. I have names and dates of those calls so now I have an extra leg to stand on with my external review! If I was told it was covered by C/S, then it should be covered! My point is take down all those names and lock them up. You never know! I would encourage everyone to call their insurance company beforehand and ask if it's covered. That way if they say it is and then deny you, you have an extra pistol in your pocket for the appeal!Dane's mom DOC Grad> > > > Well, I'm making more progress. After our great appointment at > Rehab Designs of America (CT), I left a message with my pediatrician > that I did not want to wait for the specialist to get things going. > I especially felt this way after I called the specialist's nurse to > ask her some questions and as soon as she caught wind that I had > brought Grant in for an evaluation at CT she seemed offended and put > off. She said, "Well, we don't use the DOC band. We use a better > product" about 5 times...pretty much in response to everything I said > at that point. Ugh...I don't want this to be a brand competition...I > just want to get my son taken care of ASAP. Anyway, I left the > message with the ped asking if he could go ahead and order the tests > to rule out Cranio and then consider writing the rx for the DOC > band. I also told him I would still be glad to take Grant to the > specialist appt in a few weeks, but I really wanted to start > SOMETHING now. Grant's head is growing FAST. It measured 47 > centimeters at CT yesterday (95 percentile!) and Bob at CT said that > there are actually some orthotists that won't treat a skull once it > measures 48+, because they assume the skull growth will be > substantially slower from there on. But, we are hoping that since > Grant's head has always measured large that it will continue along > that growth rate. We are hoping. But, I just want to get things > moving and not miss any more significant growth spurts. It > frustrates me thinking how MUCH it has grown since we started asking, > asking, asking our pediatrician about this. ANYWAY I got a call > from a nurse at my ped's office today telling me to take Grant to > Children's Mercy for a 'skull series' ? (CAT Skan? MRI? I'm not > sure?) TOMORROW?! I asked her if he'd write the rx after the tests > if they looked fine and she said she thought he was willing to go > that route, but we'd talk with him after the tests come back. > Halleluhah Question: Would it be a mistake for me to call my > health insurance company and ask what their coverage is on DOC band > therapy or should I wait and let CT do it if we go that route? I'm > curious to know what we're in for, financially. > > > > Thanks!> > > > > > , Mom to Grant (born 9/26/01)> > > > > > ---------------------------------> >

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In a message dated 5/22/02 10:12:53 AM Central Daylight Time,

kellysdogs@... writes:

<< The DME coverage is 100%... >>

I was covered under DME and that is how it should be covered.

Marci (mom to )

Oklahoma

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It should be covered underyour DME I wouldn't count on that reconstructive

clause unless it follows surgery for Cranio-but you never know every

insurance is different and seem to make the rules as they go along! Good

luck!

beck