insurance denial

[Guest guest]

Okay, I was thinking (and no, I didn't squash the pea:)!), what if

those of you that are experiencing insurance problems e-mail your

photos that you have posted to multiple members of your insurance

carriers? I remember how insulted I was when our authorization dept

said that a review team would decide if Abby met the criteria. These

were people who never even saw her in person. I am fortunate that

they approved our authorization, but I felt like going into the

meeting and setting Abby on the conference table & daring them to

turn her down. I just looked at Kali's photos & I can not believe

they are messing with her! The pictures are very powerful, just a

thought. These insurance analysts never get to see the personal side

of our families plight. Perhaps it would cause them to think twice.

It never occured to me to include photos (real life smile, not an x-

ray film or CT image) when we were going thru the insurance process.

I just focused on fighting & documenting. Just a thought...Kimry

PS - Kali's pics are also great because they show multiple views on

one page & are on light back ground.

[Guest guest]

Good Idea Kimry!

kg

Kimry Cook wrote:

Okay, I was thinking (and no, I didn't squash

the pea:)!), what if

those of you that are experiencing insurance problems e-mail your

photos that you have posted to multiple members of your insurance

carriers? I remember how insulted I was when our authorization

dept

said that a review team would decide if Abby met the criteria.

These

were people who never even saw her in person. I am fortunate

that

they approved our authorization, but I felt like going into the

meeting and setting Abby on the conference table & daring them

to

turn her down. I just looked at Kali's photos & I can

not believe

they are messing with her! The pictures are very powerful,

just a

thought. These insurance analysts never get to see the personal

side

of our families plight. Perhaps it would cause them to think

twice.

It never occured to me to include photos (real life smile, not

an x-

ray film or CT image) when we were going thru the insurance process.

I just focused on fighting & documenting. Just a thought...Kimry

PS - Kali's pics are also great because they show multiple views

on

one page & are on light back ground.

[Guest guest]

Kimry:

Well, you have read my mind, in a way -- not that I knew I was going to need

extra ammunition for Drs or insurance, but I did want to make sure that I

had some sort of documentation. They are going to get each " comparison "

view on one page, labeled with Dates, as well as possibly with him standing

(all the sitting views show him in the way I describe in the " developmental

question view " ) depending on how many opinions I get that this neck thing is

developmental or not....

Now I wish I had only gotten EVERY Customer Service Rep's Name when I talked

to them and recorded the date and what they told me each time I called --

and every time I had to tell my story over.... for a true " compulsive mom "

appeal! *grin*

-----Original Message-----

From: Kimry Cook [mailto:AAKARA@...]

Sent: Friday, May 19, 2000 10:25 PM

Plagiocephalyegroups

Subject: insurance denial

Okay, I was thinking (and no, I didn't squash the pea:)!), what if

those of you that are experiencing insurance problems e-mail your

photos that you have posted to multiple members of your insurance

carriers? I remember how insulted I was when our authorization dept

said that a review team would decide if Abby met the criteria. These

were people who never even saw her in person. I am fortunate that

they approved our authorization, but I felt like going into the

meeting and setting Abby on the conference table & daring them to

turn her down. I just looked at Kali's photos & I can not believe

they are messing with her! The pictures are very powerful, just a

thought. These insurance analysts never get to see the personal side

of our families plight. Perhaps it would cause them to think twice.

It never occured to me to include photos (real life smile, not an x-

ray film or CT image) when we were going thru the insurance process.

I just focused on fighting & documenting. Just a thought...Kimry

PS - Kali's pics are also great because they show multiple views on

one page & are on light back ground.

[Guest guest]

In a message dated 8/21/00 8:00:06 PM Pacific Daylight Time, tadar@...

writes:

<< We have BCBS. Do I need to call them before we go for our

appointment to see if anything will be covered? >>

I don't understand why some BCBS policies cover and some don't. We have BCBS

of Illinois-HMO. Our helmet and PT are covered at 100%. After hearing that so

many of you were denied, I started getting worried and made some calls. I

wanted to make sure that we would not be getting large bills at the end of

the year!!! I was told by ins so far first helmet (durable medical equip) was

paid at 100%. I was able to sleep better after I heard this was a sure thing.

Belinda (Indiana)

[Guest guest]

Dear ,

Yes, we had a reversal on a denial for BCBS PPO of Alabama. It took

a very intensive appeal. We worked extremely hard on it...but, in

the end they paid 80%.

We sent them a three ring binder with letters from the doctor, the

physical therapist and one from us. We also included all of the

research we could find, and a section of success stories. We used a

binder with a clear cover and made a cover sheet with our son's

picture in the band ( we had already banded him because we thought

the time factor was a big issue...and we couldn't afford to wait).

We would be happy to help you if you need anything. Whatever you do

in your appeal..........keep good records, send anything that goes in

the mail via certified mail. Otherwise they will deny that they have

received it. Don't worry about bothering them.....keep the phone

ringing...just be firm and polite.

Hope this helps.

Laurie in Tuscaloosa

(Mother of Micah....D.O.C. Band 7-24-00)

> I have read the posted letters for insurance denials. I was

> wondering if anyone has had success with Blue Cross PPO (prefered

> care blue) getting them to reverse the denials. We just had our

> molding done today. Glad that is over.

>

>

[Guest guest]

Tammy and Conner,

We live in Texas and just recently I aquired BCBS for my daughter's

insurance. Her Ped is sending us to a ENT and all of the doctors here have

now dropped BCBS. I have no idea what is going on with them. Luckly, we

will be on my husband insurance come Sept 1.

Good luck.

LuAnn and Shelbey

[Guest guest]

Dear Laurie,

Wow, thanks for the encouragement. The insurance provider said they

were making the denial of the bands nation wide so I am glad to have

your case as ammunition. I am glad I found this site yesterday or I

probably would have just turned in my little letter and hoped for the

best. Now I have so much info......I almost feel like I am in school

again writing a term paper.

I am having such a hard time with all of this. I know it is best for

but I feel so quilty that this is all my fault. As a nurse I

should have known better than to let him sleep so much on his left

side. I guess I have learned a vaulable lesson that now I must pass

on.

Thanks again for your help. I am still waiting for my big denial

letter.....its been almost 2 weeks.

> > I have read the posted letters for insurance denials. I was

> > wondering if anyone has had success with Blue Cross PPO (prefered

> > care blue) getting them to reverse the denials. We just had our

> > molding done today. Glad that is over.

> >

> >

[Guest guest]

,

I just wanted to let you know that guilt is just one of the stages we all

go through. Plus, don't think that you should have known better just because

you are a nurse; look at all of the pediatricians who are " absolutely

clueless " and in denial about the seriousness of positional plagiocephaly.

Maybe one day this will all be common knowledge, and we can put an end to

this condition. Here's hoping!

-Krista

[Guest guest]

Dear Tammy,

We used a D.O.C. band, but were nonetheless denied for

precertification. We really didn't feel that we had time to wait so

we proceeded. Thankfully Cranial Tech takes Mastercard!

Anyway, I don't know why they are so difficult.

We spent a lot of time calling and writing. It was late last night

when I posted so I forgot to mention that it is crucial to send

copies of everything to the Insurance Commissioner and let BCBS know

that you are sending those copies. I really think that turned things

in our favor.

I don't know what is going on with BCBS, they claim that each state

is completely independent of the others and are really not even

related..........however, they handled our claim completely through

Georgia's BCBS after they finally reversed the appeal........so then

we had to wait on GA to decide usual and customary and whether C.T.

was charging a fair price etc.........in the end they paid their

80%. It was a LONGGGGGGGGGGGGGGGGGGGGGGG, frustrating process.

Check out the appeal letters in the file section. We started with

Polly's letter and added and adapted to our situation. It ended up

being about 6 pages long + references, and a bibliography. We

included copies of everything we quoted from as well as additional

studies that we thought were good, and success stories. It was a

major effort......countless hours... but worth the fight.

Our son's head is sooooooooo much better.

Good Luck.

Laurie in Tuscaloosa

-- In Plagiocephalyegroups, Arnold & Tammy Roe <tadar@d...>

wrote:

> Dear Laurie,

> HELP!! We are taking our son to have a molding done for a

helmet on

> Sept .1. We have BCBS. Do I need to call them before we go for our

> appointment to see if anything will be covered? For some reason,

all of our

> local doctors are pulling out of BCBS and are not going to cover

any costs.

> What's going on??? Thanks.

> Tammy And Connor

>

> BLmusic@c... wrote:

>

> > Dear ,

> >

> > Yes, we had a reversal on a denial for BCBS PPO of Alabama. It

took

> > a very intensive appeal. We worked extremely hard on it...but,

in

> > the end they paid 80%.

> >

> > We sent them a three ring binder with letters from the doctor, the

> > physical therapist and one from us. We also included all of the

> > research we could find, and a section of success stories. We

used a

> > binder with a clear cover and made a cover sheet with our son's

> > picture in the band ( we had already banded him because we

thought

> > the time factor was a big issue...and we couldn't afford to wait).

> >

> > We would be happy to help you if you need anything. Whatever you

do

> > in your appeal..........keep good records, send anything that

goes in

> > the mail via certified mail. Otherwise they will deny that they

have

> > received it. Don't worry about bothering them.....keep the phone

> > ringing...just be firm and polite.

> >

> > Hope this helps.

> >

> > Laurie in Tuscaloosa

> > (Mother of Micah....D.O.C. Band 7-24-00)

> >

> > > I have read the posted letters for insurance denials. I was

> > > wondering if anyone has had success with Blue Cross PPO

(prefered

> > > care blue) getting them to reverse the denials. We just had our

> > > molding done today. Glad that is over.

> > >

> > >

> >

> >

> >

> >