Guest guest Posted September 4, 2002 Report Share Posted September 4, 2002 , That's a good point- I know Docs will tend to push certain brands of drugs because they may be working with a certain company, etc. It's really sad, my Neighborhood Health plan paid 100%, its absurd that companies can pick and choose what they pay for instead of it all going across the board as a general rule for approval. ' Mom Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 4, 2002 Report Share Posted September 4, 2002 , I have heard that here in Texas the HMO's (especially Cigna) are starting to tell doctors that if they refer patients to specialists, then they will subtract the fees of the specialist out of what they will pay the referring doctor. My husband heard this from a co-worker who's wife is in the industry, but I'm not sure of the validity of the info. It makes you wonder, huh! And maybe you remember that in my last denial, they accused my specialist of having financial affiliation with Cranial Tech, and that's the only reason he prescibes bands in the first place. Anything to not have to pay everything that they SHOULD pay! Oh don't get me started! Gail, Sam and Sara's mom, DOC grads Insurance and doctors It seems that a lot of insurance companies do not want to cover the cost of bands in most cases. Do you think that is one of the reasons that doctors have the "it will fix itself" attitude. That maybe they are encouraged by the insurance companies to NOT prescribe the use of a band? I was just wondering what all of you thought of that. & (5 months, banded 8/26/02)For more plagio info Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 5, 2002 Report Share Posted September 5, 2002 I think the referral 'debit' practice is standard for many HMO's. However, I do wonder if some specialists have too close an affliation with a particular product, just like some doctors prescribe certain medications based on 'incentives' that the manufacturers offer. As for the cost variations in cranial orthotics, there is definitely a for-profit element that raises the cost of the STAR Band & (especially) DOC Band over locally made helmets. In our area, the STAR band was $1800 vs $3000 for the DOC, but of course the DOC Band folks had much more training (1 month as opposed to 1 week) and experience (many patients vs a couple). It must cost CT something to develop their tech's expertise. BTW, has anyone actually paid $400 for a helmet that includes all adjustments, or is that just the cost of the device? - > , > I have heard that here in Texas the HMO's (especially Cigna) are starting to tell doctors that if they refer patients to specialists, then they will subtract the fees of the specialist out of what they will pay the referring doctor. My husband heard this from a co- worker who's wife is in the industry, but I'm not sure of the validity of the info. It makes you wonder, huh! And maybe you remember that in my last denial, they accused my specialist of having financial affiliation with Cranial Tech, and that's the only reason he prescibes bands in the first place. Anything to not have to pay everything that they SHOULD pay! Oh don't get me started! > > Gail, Sam and Sara's mom, DOC grads > Insurance and doctors > > > It seems that a lot of insurance companies do not want to cover the > cost of bands in most cases. Do you think that is one of the reasons > that doctors have the " it will fix itself " attitude. That maybe they > are encouraged by the insurance companies to NOT prescribe the use of > a band? I was just wondering what all of you thought of that. > > & (5 months, banded 8/26/02) > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 5, 2002 Report Share Posted September 5, 2002 > BTW, has anyone actually paid $400 for a helmet that includes all > adjustments, or is that just the cost of the device? I think my locally made helmet from Nopco is in the $400 range (maybe $500). Which includes the device and all subsequent visits and adjustments. So it's no wonder I had such an easy time with my insurance company covering it. I'm sure if I was asking them to cover a 3 or 4 thousand dollar device it would have raised enough flags that I would have had problems. Ken Zack and Zoey's dad Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 5, 2002 Report Share Posted September 5, 2002 Ken, I agree that the price difference is disturbing. My ortho made his own local helmet and he sold it to us at cost. He did not figure in for any profit partly because he was affiliated with a University Hospital and they were conducting research on helmets and plagio at the time. The DOCband and STARband have advertising and promotion costs and the DOCband has training and clinic costs to figure and I believe that is a large part of the difference in cost. With the locally made helmets the ortho usually makes other products and has his own office and has pursued training on his own. It is unfortunate that the " name brands " have to be more expensive, but I kind of understand why. Marci Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 6, 2002 Report Share Posted September 6, 2002 's locally made helmet was $700 which included the casting, fitting, helmet and all follow-up visits. Despite the very reasonable price I still had to go through the entire appeals process and an external review to get coverage. I was shocked that they wouldn't pay the claim considering the excellent price, but the insurance companies are all about saving a buck if they can. Marci (Mom to ) Oklahoma Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.