Re: & Grace from Theresa & Jessie

[Guest guest]

Theresa~

Grace wore a locally made helmet that was made by an orthotist at a local childrens hospital here in town. So looking at the way they billed her helmet it was billed by the hospital with a code that translates into "prosthetic- orthotic device". Because it was from a hospital they used a hospital revanue code ub274 I am going to keep looking to see what the procedure code that went along with it is. I have been searching the L codes which are orthotic prosthetic devices which I know is what the orthotist billed. Which makes more sense then them billing yours with the e1399 dump code. The helmets/bands are not durable medical equip. they are more orthotic . I will be going back on the system later this afternoon and I will let you know what I find out. I know that a lot of times they won't pay the dump codes without more research when they are for a high dollar amount. I hope that made sense and didn't sound like a lot of insurance mumbo jumbo. Sometimes I only think in insurance terms! I have been doing it for tooooo long!

and Grace

[Guest guest]

Hmmmm well maybe it is the different areas and how they cover? I was just going by what Theresa was saying about the E1399. If it is covered as DME with the E1399 dump code then maybe that is not what it was denied for.

Sorry

and Grace

[Guest guest]

Debbie~ I was just trying to give the view from the insurance companies perspective. What makes sense to you and I is not always how the insurance companies see it. They pay things based on codes and the info needed to support the codes etc. I was hoping to be helpful and give info that I have access to but I am just going to let it go I don't want to cause a problem

Sorry again I hope that Theresa and Jessie get things taken care of

and Grace

[Guest guest]

Debbie~ I am just having a really bad day and I feel like I don't have any help to offer the group anymore. I have tried to be helpful to others the way they have been to me and it just seems like I get shot down a lot for it. Maybe it is just an oversensitive day I don't know? But it is probably better for me to just watch from the wings so that I don't get my feelings hurt Thanks again as always for all your help and support with Grace.

and Grace

[Guest guest]

,

I can't imagine why you would feel that way!!! I think you are a tremendous

help to the group and have so much insight to offer- and I know all of the

moderators and group members feel the same way as they have gotten great tips

from you, etc.! I think its especially hard to translate certain things and

how they are said, its certainly not like a conversation where we can debate

things- and every word can be scrutinized- but I think everyone has so much

to offer- your contribution is so huge- don't stop now!!!!!!! Hugs to you- I

hope your day gets better!

'Mom

[Guest guest]

Which makes more sense then them billing yours with the e1399 dump

code. The helmets/bands are not durable medical equip. they are more

orthotic

I don't know why or how they are considered DME, but that's how my

insurance covered Abby's bands. 50% coverage. I know of others who

had their bands covered as DME as well.

Debbie Abby's mom DOCgrad

MI

[Guest guest]

>

> I don't know why or how they are considered DME, but that's how my

> insurance covered Abby's bands. 50% coverage. I know of others

who

> had their bands covered as DME as well.

>

> Debbie Abby's mom DOCgrad

> MI

A p.s. to that: I didn't have BCBS insurance, I have a local health

ins provider!

Debbie

[Guest guest]

> Hmmmm well maybe it is the different areas and how they cover? I

was just

> going by what Theresa was saying about the E1399. If it is covered

as DME

> with the E1399 dump code then maybe that is not what it was denied

for.

> Sorry

> and Grace

:

Don't be sorry!!!! I just wanted to say that some insurances do

cover the bands as DME for some reason! Give us all the codes you

can that'll help! Thanks

Debbie Abby's mom

MI

[Guest guest]

> Debbie~ I was just trying to give the view from the insurance

companies

> perspective. What makes sense to you and I is not always how the

insurance

> companies see it. They pay things based on codes and the info

needed to

> support the codes etc. I was hoping to be helpful and give info

that I have

> access to but I am just going to let it go I don't want to cause a

problem

> Sorry again I hope that Theresa and Jessie get things taken care of

> and Grace

:

I think you totally misinterpreted what I was " saying " .! You are

hardly causing any problem here, you are being extremely helpful!

Please don't let it go, Theresa needs your help as do our other

members! Again, I think you misinterpreted what I was saying - I'm

sorry! I hope you don't think I was upset with you in ANY way, cuz I

most certainly am not - I really appreciate you helping our Theresa!

Please please please, keep helping! The only thing I was saying is

that my ins. covered the band as DME (who knows why!?).

So please, please please please, don't think you caused any problem!

I'm sorry for the way my email might have been interpreted! Don't

worry please! I'm worried now I upset or offended you! SORRY!

HUGS

Debbie Abby'smom

MI