Blue Cross/Blue Shield New Jersey

[Guest guest]

I'm new to this group and just learning about this condition as my 4

month old daughter requires this treatment. I am waiting for BC/BS

NJ to advise if they will cover this treatment. I was alerted by the

Doctor's office that they have been denying this deaming it

cosmetic. Has anyone been approved by them? If I'm denied I've been

told to appeal. How long does an appeal take? Can I start the

treatment and pay out of pocket while I'm in appeals and if it's

approved will they reimburse for what has been paid? I'm sorry for

so many questions but I am trying to do things correctly. I am also

scared of waiting too long....now that I know she needs this done I

want to take care of it asap.

Thank you

Barbara

[Guest guest]

Hi Barbara and welcome - don't apologize for the questions! That's what we

are here for - fire away!!!

Unfortunately lots of insurance companies are as ignorant as some of the drs

around about plagio. Many people here are denied based on " not medically

necessary (cosmetic) " . Appeals can take a very long time, so once you have

the initial denial, if you can afford to pay upfront and continue the fight

that is best. We were completely finished with treatment when we finally won

the appeal and got the money!! If you can get a letter of medical necessity

from your specialist (and ped if possible) it will help if you have to fight

the " not medically necessary " denial. BCBS varies from state to state, but

there are people in the group that have had the treatment paid for by BCBS.

Best wishes and please keep us posted!

Marci (Mom to )

Oklahoma

[Guest guest]

Hi, I have BCBS of Oregon and should be receiving an

answer to my appeal this week. I received my

prescription for the DOC band and it took the

insurance one month to deny the preauthorization.

Fortunately, my daughter was young enough, that one

month didn't make a difference in treatment time (she

was banded @ 5 mo's). I went ahead and paid for the

treatment upfront and let Cranial Therapies bill the

insurance and they will reimburse me if my appeal is

successful. I just saw somebody with BCBS of land

post that their appeal was successful, so that gives

me hope. I hope your insurance approves your band

right off the bat. If not, this group has some great

appeals letters on their site. They denied us on the

basis " not medically necessary. " Good luck.

, 's mom

Southern California

--- catasofia2002 <catasofia2002@...> wrote:

> I'm new to this group and just learning about this

> condition as my 4

> month old daughter requires this treatment. I am

> waiting for BC/BS

> NJ to advise if they will cover this treatment. I

> was alerted by the

> Doctor's office that they have been denying this

> deaming it

> cosmetic. Has anyone been approved by them? If I'm

> denied I've been

> told to appeal. How long does an appeal take? Can

> I start the

> treatment and pay out of pocket while I'm in appeals

> and if it's

> approved will they reimburse for what has been paid?

> I'm sorry for

> so many questions but I am trying to do things

> correctly. I am also

> scared of waiting too long....now that I know she

> needs this done I

> want to take care of it asap.

>

> Thank you

> Barbara

>

>

>

__________________________________________________