Re: HAVE BLUE CROSS BLUE SHIELD FEDERAL EMPLOYEE INS.

[Guest guest]

KP, Are you telling me that it has taken 6 months for them to make a decision? I know in our case (United Health Care), it was a nurse who gave the preauthorization. I don't know if she was also the person who made the final decision, but we were approved without any appeals. Wouldn't it be interesting to know what their background is? I'm sure that regardless of their feelings about something, the insurance company has guidlelines about what to pay and what not to pay. It's unfortunate! OUr babies suffer as these companies make millions of dollars.

Ana & Jace

spplagio <RPETE728@...> wrote: My son is 13 months old and has had his DOC since 7 months. Cranial Tech in Paramus called our insurance to see if we need pre-authorization and they told them we didn't and that it was covered under durable medical equipment. Low and behold we were denied...they say it is not medically necessary even though our neurosurgeon sent a letter of medical necessity. I have spent days calling to find out the specialty of the "medical advisor" making these decisions and finally found out that Agnes an RN is making the medical decisions! I am in appeals and will fight this until they pay something. I have posted on cranialtech.com under CIGNA case a link to view a case in which a family sued CIGNA and won for the same reasons. There is also a case for BCBS in Chicago.KPFor more plagio info

[Guest guest]

KP,

Argh! How frustrating! It's amazing how an RN is more qualified to determine

medical necessity then a specialist - NOT!! Good luck with your appeal,

however, I think you have an excellent chance of overturning that one.

Marci (Mom to )

Oklahoma