Re: Insurance Issue Question?

[Guest guest]

Shimi,

We have AEtna US Healthcare of New Jersey, they have pre-approved 80%

payment for us (in writing). They required the measurements for us too.

We go to Cranial Tech. in Paramus, NJ and they did the measurements, not

our ped., not even our neurosurgeon did this. Our OT used an instrument

that looked like calipers, not all that scientific. We were told that in

order for Aetna to pay, 2/3 measurements had to be over 6 mm. CT also

took pictures from all angles to submit to the ins. co. I would highly

recommend getting this done. The hair was lightly oiled so that the true

shape of the head could be seen. I'm sure you could call the CT office,

201-265-3993, speak to Charlotte. You could also go for a free consult

there as well. We travel 21/2-3 hours one way to the office. A long

drive might be worth $3000.00!

Best of luck!

Ellen (Mom to Amy)

New Jersey

On Tue, 16 Jul 2002 10:53:33 -0400 " csdaly " <csdaly@...> writes:

> Hi everyone,

>

> I want to first of all say what a great resource you guys are!!!!

> My name is Shimi and I have twin boys and .

>

> They were diagnosed with Plagio at 3 months and they are now a

> little over 6 months. I'm going through a battle with my insurance

> AEetna US Healthcare of Pennsylvania. I was wondering if anyone has

> gotten AEtna to cover a helment/band. Currently, the insurance

> company is asking for measurements with an instrument that our

> pediatric neurosurgeon at St. does not own and he does

> not know of anyone that has this instrument either. Any info anyone

> has would be great. My husband and I are ready to fork up the

> payment on our own b/c we can't wait any longer.

>

> Thank you in advance.

>

> Shimi

> and (6 months)

________________________________________________________________

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[Guest guest]

On Tue, 16 Jul 2002 16:28:20 -0400 Ellen Hemple <hemplee@...> wrote:

Shimi,

We have AEtna US Healthcare of New Jersey, they have pre-approved 80%

payment for us (in writing).  They required the measurements for us too.

We go to Cranial Tech. in Paramus, NJ and they did the measurements, not

our ped., not even our neurosurgeon did this.  Our OT used an instrument

that looked like calipers, not all that scientific.  We were told that in

order for Aetna to pay, 2/3 measurements had to be over 6 mm.  CT also

took pictures from all angles to submit to the ins. co.  I would highly

recommend getting this done.  The hair was lightly oiled so that the true

shape of the head could be seen.  I'm sure you could call the CT office,

201-265-3993, speak to Charlotte.  You could also go for a free consult

there as well.  We travel 21/2-3 hours one way to the office.  A long

drive might be worth $3000.00!

Best of luck!

Ellen (Mom to Amy)

New Jersey

On Tue, 16 Jul 2002 10:53:33 -0400 " csdaly " <csdaly@...> writes:

> Hi everyone,

>

> I want to first of all say what a great resource you guys are!!!! 

> My name is Shimi and I have twin boys and .

>

> They were diagnosed with Plagio at 3 months and they are now a

> little over 6 months.  I'm going through a battle with my insurance

> AEetna US Healthcare of Pennsylvania.  I was wondering if anyone has

> gotten AEtna to cover a helment/band.  Currently, the insurance

> company is asking for measurements with an instrument that our

> pediatric neurosurgeon at St. does not own and he does

> not know of anyone that has this instrument either.  Any info anyone

> has would be great.  My husband and I are ready to fork up the

> payment on our own b/c we can't wait any longer.

>

> Thank you in advance.

>

> Shimi

> and (6 months)

________________________________________________________________

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Join Juno today!  For your FREE software, visit:

<a

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[Guest guest]

Shimi,

Hello and welcome to the group! I believe I have heard of instances where Aetna

covered the band. Of course, coverage varies from state to state and I'm not

sure if I've heard of someone in PA getting covered by Aetna. Hopefully someone

from your area has had some experience wtih Aetna. Can your specialist send you

to an orthotist to get the measurements? My special did not take any

measurements - that was left to the orthotist. If your specialist can send you

to see the ortho perhaps that person could get the measurements Aetna requires.

Many insurance companies do require measurements and they have to be past a

certain point before coverage will be extended.

Good luck and I'm glad you have joined our group!

Marci (mom to )

Oklahoma

[Guest guest]

Ellen,

Thanks for the response. We had just gotten off the phone with the insurance company and they tell us that they will not cover us if we go to Cranial Tech. We asked them what the name of the instrument was and they told us that they will try to get a hold of the nurse who contacted the neurosurgeon and call us back. We then asked if we could speak to the nurse that works at Aetna but we were told we were not allowed to speak with her. Basically, they are just giving us the run around. We actually have an appt with Harry J. Lawall on Monday to do the measurements.

Thanks for the luck...I know we'll need it!!!

Shimi

and (6 months)

Re: Insurance Issue Question?

Shimi,We have AEtna US Healthcare of New Jersey, they have pre-approved 80%payment for us (in writing). They required the measurements for us too. We go to Cranial Tech. in Paramus, NJ and they did the measurements, notour ped., not even our neurosurgeon did this. Our OT used an instrumentthat looked like calipers, not all that scientific. We were told that inorder for Aetna to pay, 2/3 measurements had to be over 6 mm. CT alsotook pictures from all angles to submit to the ins. co. I would highlyrecommend getting this done. The hair was lightly oiled so that the trueshape of the head could be seen. I'm sure you could call the CT office,201-265-3993, speak to Charlotte. You could also go for a free consultthere as well. We travel 21/2-3 hours one way to the office. A longdrive might be worth $3000.00!Best of luck!Ellen (Mom to Amy)New JerseyOn Tue, 16 Jul 2002 10:53:33 -0400 "csdaly" <csdaly@...> writes:> Hi everyone,> > I want to first of all say what a great resource you guys are!!!! > My name is Shimi and I have twin boys and .> > They were diagnosed with Plagio at 3 months and they are now a > little over 6 months. I'm going through a battle with my insurance > AEetna US Healthcare of Pennsylvania. I was wondering if anyone has > gotten AEtna to cover a helment/band. Currently, the insurance > company is asking for measurements with an instrument that our > pediatric neurosurgeon at St. does not own and he does > not know of anyone that has this instrument either. Any info anyone > has would be great. My husband and I are ready to fork up the > payment on our own b/c we can't wait any longer.> > Thank you in advance.> > Shimi> and (6 months)________________________________________________________________GET INTERNET ACCESS FROM JUNO!Juno offers FREE or PREMIUM Internet access for less!Join Juno today! For your FREE software, visit:http://dl.www.juno.com/get/web/.For more plagio info