Guest guest Posted June 20, 2000 Report Share Posted June 20, 2000 Hi Ann, It's already been done as quite a number of double-blind trials have been done - by the medical profession's own rules, it's proven. Insurance companies are behind the times. It might help if you print off some of the studies which have been done from rheumatic.org/studies.htm. Chris. >Apparnetly insurance companies consider abx for arthritis to be >'experimental'. > >Does anyone have any idea when results will be released and the >powers that be will then approve it as beneficial and therefore >viable claim? > >TIA Ann > >------------------------------------------------------------------------ >Find long lost high school friends: >1/5535/0/_/532797/_/961482231/ >------------------------------------------------------------------------ > >To unsubscribe, email: rheumatic-unsubscribeegroups > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 20, 2000 Report Share Posted June 20, 2000 I best get to reading and printing then. Reading is part of my eye problems, so I tend not to do much of it. Thanks and gearing up for the battle! Adlard wrote: > > Hi Ann, > > It's already been done as quite a number of double-blind trials have been done > - by the medical profession's own rules, it's proven. Insurance companies are > behind the times. > > It might help if you print off some of the studies which have been done from > rheumatic.org/studies.htm. > > Chris. > > >Apparnetly insurance companies consider abx for arthritis to be > >'experimental'. > > > >Does anyone have any idea when results will be released and the > >powers that be will then approve it as beneficial and therefore > >viable claim? > > > >TIA Ann > > > >------------------------------------------------------------------------ > >Find long lost high school friends: > >1/5535/0/_/532797/_/961482231/ > >------------------------------------------------------------------------ > > > >To unsubscribe, email: rheumatic-unsubscribeegroups > > > > > > > > ------------------------------------------------------------------------ > Free Conference Calling with Firetalk! > Host your next egroup meeting live on Firetalk. > Click here! > 1/5478/0/_/532797/_/961487832/ > ------------------------------------------------------------------------ > > To unsubscribe, email: rheumatic-unsubscribeegroups Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 20, 2000 Report Share Posted June 20, 2000 Depending on insurance company, the definition of " proven " may be that the FDA/NIH has <B>PUBLISHED</B> it as an acceptable protocol. For example: peptic ulcer treatment using antibiotic is now 'proven' <UL><LI>http://www.niddk.nih.gov/health/digest/pubs/hpylori/hpylori.ht m <LI> http://www.nlm.nih.gov/pubs/cbm/pepulcer.html shows the size of the biography that is often needed. </OL> So when you go to http://www.nih.gov/niams/reports/lappin.htm " Arthritis: What We Know Today " and antibiotics are not cited... then it is easy to claim that it is 'experimental'. or worst still " <B>The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) requests applications to initiate a pilot clinical study designed to test the hypothesis that intravenous antibiotic therapy is an effective and safe treatment for rheumatoid arthritis.</B> " http://grants.nih.gov/grants/guide/rfa-files/RFA-AR-94-006.html <HR> The 'pole' to be jumped to move from an experimental to accepted treatment is very high (and also very political often). Antibiotics for CFIDS is still experimental even with 85=95% major success rates with over 4000 documented cases - <I>and I don't expect that to change for at least 10-15 years</I>. ONCE, it is accepted (politically) to seriously trial it, there will be level I, 2, and 3 trials. Each trial will likely take 3-5 years (especially since expected duration of each is at least 2 years).... so around 2021, antibiotics for CFIDS may become 'accepted'. With RA the scenario is similar.... because <U>of the long duration of the trials</U>... > Hi Ann, > > It's already been done as quite a number of double-blind trials have been done > - by the medical profession's own rules, it's proven. Insurance companies are > behind the times. > > It might help if you print off some of the studies which have been done from > rheumatic.org/studies.htm. > > Chris. > > >Apparnetly insurance companies consider abx for arthritis to be > >'experimental'. > > > >Does anyone have any idea when results will be released and the > >powers that be will then approve it as beneficial and therefore > >viable claim? > > > >TIA Ann > > > >------------------------------------------------------------------- ----- > >Find long lost high school friends: > >1/5535/0/_/532797/_/961482231/ > >------------------------------------------------------------------- ----- > > > >To unsubscribe, email: rheumatic-unsubscribeegroups > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 20, 2000 Report Share Posted June 20, 2000 > Does anyone have any idea when results will be released and the > powers that be will then approve it as beneficial and therefore > viable claim? > > TIA Ann Are you having problems getting antibiotics covered by your insurance, Ann? I was able to get Biaxin covered just by the pharmacist telling them of the literature concerning mycoplasmal infections as possible co-factors in RA. If they are very stubborn, perhaps a mycoplasma positive test would convince them to cover it? (whether they believe it is a factor in the RA or not) Sheesh, compare the price of a little Biaxin or Minocin to the cost of joint replacements, they are shooting themselves in the foot...... Liz G Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 4, 2002 Report Share Posted December 4, 2002 Hi Kristy, At 3 the school district takes over Savannah's services. If you can build a case on why this pre-school can provide a more appropriate education than the one your local school district offers you may be able to get them to pick up the cost. I would contact your local district now to get the ball rolling. They will evaluate her and then as a team, you and them determine what is a FAPE free and appropriate public education. Get all your evals in order, progress reports from the current school to show what progress has been made. Depending upon where you are some districts may outsource while others prefer to keep the kids in-house which sometimes is where the discrepancy lies. See if you can view their classrooms, meet their SLPs, teachers, etc... I myself am fortunate to have a decent district so I never went to bat for an out of district placement. Perhaps others can tell you what made them successful. Good luck. > Hi. This is Kristy. I have a question for all of you all who have had > success fighting with the insurance company. My problem is not that they > have denied speech services. We have been going to a wonderful early > intervention program. It is a preschool with 4 kids that have developmental > problems and 2 kids that are normal developing and 2 master level teachers in > this class. Savannah has learned so much!! The speech therapist provides > her with one-on-one speech therapy and she has made alot of improvement. The > problem is Savannah is going to turn 3 in March. Our insurance company says > that they will not consider this hospital preschool as in- network. We can > not afford the out of network costs. The only other in network providers > they offer is straight speech with no developmental preschool. Is there > anyway that I can appeal this decision based on the fact that the in network > facilities do not have a developmental preschool? If anyone has any ideas, > please let me know. I am going to try everything that I can to keep her in > this preschool. > > Thanks again for all of your help! > > Oh, by the way, this preschool bills the insurance company for speech > services only and then the hospital takes care of the preschool charges. So > they bill for a 45 minute session but Savannah gets to stay at the preschool > 3 hours a day. > > Many Blessings, > > Kristy Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 5, 2002 Report Share Posted December 5, 2002 It depends on where you live (I guess) that the school district takes over at age 3. I know that here in Oregon they do not until the child reaches Kindergarten. All EI services are through our ESDs. Here in Oregon, school districts have more funding to provide services; ESDs traditionally provide bare bones services. Sadly, education in general is suffering here in Oregon because of the lack of funding. There have been millions in budget cuts. It's a dark day. In fact, Portland Public Schools is trying to decrease the school year by 3 weeks! in order to save money. Kristy would have to check to see who is paying for Savannah's services and then go from there. ----- Original Message ----- > Hi. This is Kristy. I have a question for all of you all who have had > success fighting with the insurance company. My problem is not that they > have denied speech services. We have been going to a wonderful early > intervention program. It is a preschool with 4 kids that have developmental > problems and 2 kids that are normal developing and 2 master level teachers in > this class. Savannah has learned so much!! The speech therapist provides > her with one-on-one speech therapy and she has made alot of improvement. The > problem is Savannah is going to turn 3 in March. Our insurance company says > that they will not consider this hospital preschool as in- network. We can > not afford the out of network costs. The only other in network providers > they offer is straight speech with no developmental preschool. Is there > anyway that I can appeal this decision based on the fact that the in network > facilities do not have a developmental preschool? If anyone has any ideas, > please let me know. I am going to try everything that I can to keep her in > this preschool. > > Thanks again for all of your help! > > Oh, by the way, this preschool bills the insurance company for speech > services only and then the hospital takes care of the preschool charges. So > they bill for a 45 minute session but Savannah gets to stay at the preschool > 3 hours a day. > > Many Blessings, > > Kristy Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 9, 2003 Report Share Posted June 9, 2003 Hi: Sorry to hear that, but it's very common. First you need to find out if Chips will cover your band, unfortunatley a lot of insurance companies won't cover for helmets/bands, then, if they do cover helmets/bands you will need to take you child off BCBS insurance I think no insurance will cover when they know you have insurance already, or at least that what i understand unless you lied and said that he doesn't have insurance, but I don't think that's a good idea. Another advise I can give you is to go to your nearest children hospital and let them know your problem, some hospitals will help you finance the band or they can pay it all off for you. Where there is a will it's always a way Good Luck and keep us posted. and > Ok~ > > Bryce is covered by BCBS of Texas which wont pay for his band. So I was > filling out the application online for CHIPS b/c we dont have the money to > just pay for his band and we qualify for CHIPS program. Anyways, there was > this one part that said " If you dont live with the child or your child > alreday has health coverage you need to log out of this program now. " I dont > understand it is a type of medicade, but its not free. I mean you only or we > would have to pay 18$ a month for coverage for Bryce. So that means he can > be covered under it or at least that is what i thought. You can have double > coverage right? So if it is not free and we would pay for it every month > then why wouldnt he be able to be covered b/c of BCBS. I thought you could > have double coverage? I am just really confused right now and mad kind of. > CHIPS was our only hope! Please somebody help me out here. > > Rhiannon > Bryce 10.5 months > > _________________________________________________________________ > Protect your PC - get McAfee.com VirusScan Online > http://clinic.mcafee.com/clinic/ibuy/campaign.asp?cid=3963 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 9, 2003 Report Share Posted June 9, 2003 Rhiannon, I believe CHIPS is for people who do not have any coverage for their children and can not afford any other insurance plan..You would have to drop BCBS in order to have CHIPS...You can be double covered, but not by a state agency and another company.. Good luck! Randi mom to Drew 6 months DOC band 4-28 > Ok~ > > Bryce is covered by BCBS of Texas which wont pay for his band. So I was > filling out the application online for CHIPS b/c we dont have the money to > just pay for his band and we qualify for CHIPS program. Anyways, there was > this one part that said " If you dont live with the child or your child > alreday has health coverage you need to log out of this program now. " I dont > understand it is a type of medicade, but its not free. I mean you only or we > would have to pay 18$ a month for coverage for Bryce. So that means he can > be covered under it or at least that is what i thought. You can have double > coverage right? So if it is not free and we would pay for it every month > then why wouldnt he be able to be covered b/c of BCBS. I thought you could > have double coverage? I am just really confused right now and mad kind of. > CHIPS was our only hope! Please somebody help me out here. > > Rhiannon > Bryce 10.5 months > > _________________________________________________________________ > Protect your PC - get McAfee.com VirusScan Online > http://clinic.mcafee.com/clinic/ibuy/campaign.asp?cid=3963 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 30, 2003 Report Share Posted June 30, 2003 Hi everyone, I know this had been addressed before but I don't seem to remember. My insurance denied due to investigational/cosmetic purposes, where is the letter that states differently? Thank you, Sam, mom to Ethan 10 months Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 30, 2003 Report Share Posted June 30, 2003 All of these links have helpful information about fighting your insurance. Good luck! Jen- TXTrentyn- 13 mo. DocBand 06/12/03 Plagiocephaly/files/Help%20Folder/INSURANCE%20HELP/ http://www.cappskids.org/PlagioInsuranceHelp.htm http://www.plagiocephaly.org/resources/insurance.htm http://www.plagiocephaly.org/support/insurance.htm Re: Insurance question Hi everyone,I know this had been addressed before but I don't seem to remember. My insurance denied due to investigational/cosmetic purposes, where is the letter that states differently?Thank you,Sam, mom to Ethan 10 months For more plagio info Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 12, 2003 Report Share Posted October 12, 2003 Hi : Hey...we just won our appeal with Cigna. You can email me anytime for any info. Keep at it...you'll win...on was denied at first because it was not medically necessary..it was overturned. Good luck and keep us posted. Lori and on DOCGRAD 9/19 > Hi Ian & Group Members > > Ian: Could you please let me know what the name of your website and book > is? I have a 9 month old son whose consult with the neurosurgeon (in order > to diagnose his tort and plagio); as well as, his helmet were denied by my > insurance (Cigna). I would like to investigate how I can win my appeal once > I begin the process. > > Ian & Group: Does anyone else have any information as to CAPE/Blue Shield > or Kaiser accepting plagio as a legit disorder. October is my job's open > enrollment period and I have an opportunity to change from Cigna over to > Kaiser or CAPE/Blue Shield. If one of these two insurance carriers approves > my son, I can begin physical therapy and banding in 1/04. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 7, 2003 Report Share Posted November 7, 2003 Does your child have congenital torticollis? If so you could use that. What is your insurance company? (DOCband grads mom)bamagurl96 <bamagurl96@...> wrote: Insurance has been denied for Caroline's STARBand, so now I am working on the appeal. There is an exclusion in our policy that reads,Exclusions:Plastic or cosmetic surgical procedures or services performed to improve appearance or to correct a deformity without restoring a bodily function, unless such services are Medically Necessary and due to physical trauma, surgery, or congenital anomaly noted at birth.I think I can cover the Medically Necessary part, but does anyone have any advice on how to cover the part that reads,"correct a deformity without restoring a bodily function". What would the bodily function entail?? I have been reviewing all the appeals letters under the Files section, but so far have not come across anything that addresses this. Any help would be greatly appreciated!For more plagio info Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 7, 2003 Report Share Posted November 7, 2003 No she doesn't have congenital torticollis. My insurance is Companion Healthcare BCBS of South Carolina. > Insurance has been denied for Caroline's STARBand, so now I am > working on the appeal. There is an exclusion in our policy that reads, > > Exclusions: > > Plastic or cosmetic surgical procedures or services performed to > improve appearance or to correct a deformity without restoring a > bodily function, unless such services are Medically Necessary and due > to physical trauma, surgery, or congenital anomaly noted at birth. > > > I think I can cover the Medically Necessary part, but does anyone > have any advice on how to cover the part that reads, " correct a > deformity without restoring a bodily function " . What would the bodily > function entail?? I have been reviewing all the appeals letters under > the Files section, but so far have not come across anything that > addresses this. Any help would be greatly appreciated! > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 7, 2003 Report Share Posted November 7, 2003 I di not have to appeal on that particular issues - I am sure other will chime in - BUT what about listing potential problems that could arise without treatment. Like the fact that safetly helmets (bike, sports) will not fit correctly and could put a child at risk or the possibility that asymmetry would result in jaw misalignment or problems with ear tubes (increased ear infections) or headaches. I don't know that anyone has proof of these things but I think I have heard of others using this type of info in their appeals. Debbie c - doc grad --- In Plagiocephaly , " bamagurl96 " <bamagurl96@y...> wrote: > Insurance has been denied for Caroline's STARBand, so now I am > working on the appeal. There is an exclusion in our policy that reads, > > Exclusions: > > Plastic or cosmetic surgical procedures or services performed to > improve appearance or to correct a deformity without restoring a > bodily function, unless such services are Medically Necessary and due > to physical trauma, surgery, or congenital anomaly noted at birth. > > > I think I can cover the Medically Necessary part, but does anyone > have any advice on how to cover the part that reads, " correct a > deformity without restoring a bodily function " . What would the bodily > function entail?? I have been reviewing all the appeals letters under > the Files section, but so far have not come across anything that > addresses this. Any help would be greatly appreciated! > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 7, 2003 Report Share Posted November 7, 2003 Hi , I think that the American Medical Association Resolution 119 has information that you need. It can be found at http://www.cappskids.org/res119.pdf. Jill Ethan (DOC band #2 10-29-03) --- In Plagiocephaly , " bamagurl96 " <bamagurl96@y...> wrote: > Insurance has been denied for Caroline's STARBand, so now I am > working on the appeal. There is an exclusion in our policy that reads, > > Exclusions: > > Plastic or cosmetic surgical procedures or services performed to > improve appearance or to correct a deformity without restoring a > bodily function, unless such services are Medically Necessary and due > to physical trauma, surgery, or congenital anomaly noted at birth. > > > I think I can cover the Medically Necessary part, but does anyone > have any advice on how to cover the part that reads, " correct a > deformity without restoring a bodily function " . What would the bodily > function entail?? I have been reviewing all the appeals letters under > the Files section, but so far have not come across anything that > addresses this. Any help would be greatly appreciated! > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 8, 2003 Report Share Posted November 8, 2003 , Check out my appeal in the insurance files section. There are many reasons why it should be covered on a child and the AMA agrees. help folder - insurance help folder - contract exclusion appeal folder Plagiocephaly/files/Help%20Folder/INSURANCE%20HELP/Contract%20Exclusion%20Appeal/ HTH na/DOC/1.5 wks/SC/4.5 mos (still appealing insurance) Insurance Question Insurance has been denied for Caroline's STARBand, so now I am working on the appeal. There is an exclusion in our policy that reads,Exclusions:Plastic or cosmetic surgical procedures or services performed to improve appearance or to correct a deformity without restoring a bodily function, unless such services are Medically Necessary and due to physical trauma, surgery, or congenital anomaly noted at birth.I think I can cover the Medically Necessary part, but does anyone have any advice on how to cover the part that reads,"correct a deformity without restoring a bodily function". What would the bodily function entail?? I have been reviewing all the appeals letters under the Files section, but so far have not come across anything that addresses this. Any help would be greatly appreciated!For more plagio info Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 8, 2003 Report Share Posted November 8, 2003 , My insurance is Companion BCBS of SC. I just posted another note to you. My daughter does have torticollis and my company is self insured. This is a slightly different scenario than yours but please feel free to use my files. Re: Insurance Question No she doesn't have congenital torticollis. My insurance is Companion Healthcare BCBS of South Carolina.> Insurance has been denied for Caroline's STARBand, so now I am > working on the appeal. There is an exclusion in our policy that reads,> > Exclusions:> > Plastic or cosmetic surgical procedures or services performed to > improve appearance or to correct a deformity without restoring a > bodily function, unless such services are Medically Necessary and due > to physical trauma, surgery, or congenital anomaly noted at birth.> > > I think I can cover the Medically Necessary part, but does anyone > have any advice on how to cover the part that reads,"correct a > deformity without restoring a bodily function". What would the bodily > function entail?? I have been reviewing all the appeals letters under > the Files section, but so far have not come across anything that > addresses this. Any help would be greatly appreciated!> > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 15, 2003 Report Share Posted November 15, 2003 Hmmm, interesting question. If Logan's head is round now I'm not even sure that he could be banded but I could be wrong. CT will be able to tell you in the evaluation. As for insurance, check out the DATABASE section, there is a section about whose insurance paid what that may help you. I had BCBS pay 90% easily but I know others that are still battling with BCBS. I'll be curious to know what CT says, please keep us posted! Natasha --- In Plagiocephaly , " erinnfp " <tuesdayef@a...> wrote: > I need some help. Logan was diagnosed with Plagio when he was about > 4.5 months old. We originally went to CT in Paramus for an > evaluation, and we loved them. Unfortunately our insurance company, > Oxford, did not and would only pay for a band from Hanger > Prosthetics. Logan has been in his Hanger band for about 4 months > now (he is 9.5 months) and although I see great improvement in his > head, I still see the facial assymatry (his forhead, ears, eyes) and > that concerns me the most. I was thinking of going back to CT & > seeing if they thought they can improve on his facial assymatry at > all, and then trying for another band. Has anyone had to do this? > Also I am going to change Insurance co., for next year so hopefully > one would cover the CT band. What insurance companies have been for > a CT band without appeals? > I thank you so much for your help. > n Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 16, 2003 Report Share Posted November 16, 2003 I would hope so--- with Connor I'm much more concerned with the facial symmetry then whether or not his head is a little flat... I figure he can grow hair for the head, but its frowned upon to wear it covering your face... Let me know how it goes.. > I need some help. Logan was diagnosed with Plagio when he was about > 4.5 months old. We originally went to CT in Paramus for an > evaluation, and we loved them. Unfortunately our insurance company, > Oxford, did not and would only pay for a band from Hanger > Prosthetics. Logan has been in his Hanger band for about 4 months > now (he is 9.5 months) and although I see great improvement in his > head, I still see the facial assymatry (his forhead, ears, eyes) and > that concerns me the most. I was thinking of going back to CT & > seeing if they thought they can improve on his facial assymatry at > all, and then trying for another band. Has anyone had to do this? > Also I am going to change Insurance co., for next year so hopefully > one would cover the CT band. What insurance companies have been for > a CT band without appeals?> I thank you so much for your help. > n For more plagio info Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 16, 2003 Report Share Posted November 16, 2003 Hi n: I'm glad to hear Logan has seen correction with his flatness. Asymmetries are often the last & most difficult area to see correction in We've had several members switch from one band to another for whatever reason, myself included. I think most have had success getting their ins. to cover the DOCband they switched to. Let us know what you decide to do. Good luck. Keep us posted. Debbie Abby's mom DOCGrad MI --- In Plagiocephaly , " erinnfp " <tuesdayef@a...> wrote: > I need some help. Logan was diagnosed with Plagio when he was about > 4.5 months old. We originally went to CT in Paramus for an > evaluation, and we loved them. Unfortunately our insurance company, > Oxford, did not and would only pay for a band from Hanger > Prosthetics. Logan has been in his Hanger band for about 4 months > now (he is 9.5 months) and although I see great improvement in his > head, I still see the facial assymatry (his forhead, ears, eyes) and > that concerns me the most. I was thinking of going back to CT & > seeing if they thought they can improve on his facial assymatry at > all, and then trying for another band. Has anyone had to do this? > Also I am going to change Insurance co., for next year so hopefully > one would cover the CT band. What insurance companies have been for > a CT band without appeals? > I thank you so much for your help. > n Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 8, 2004 Report Share Posted April 8, 2004 Hello, My son is 11 months old and was DOC banded 4 weeks ago for plagio due to right tort. I also have a BCBS product but here in NJ and had no trouble getting his band approved. However, as a former Benefits Analyst (quit my job 2 months ago), it isn't just the insurance company, but your specific plan that will determine whether it will be approved or not. My first recommendation is to go to your benefits office and ask for a SPD (summary plan description). By law, they have to provide this to you if requested. In there it should tell you what the plans coverage is for Durable Medical Goods. Orthodics will fall under that classification. If they cover Durable Medical Goods, you can then call BCBS and find out if if they cover it and what sort of authorization you will need. As a PPO, you have the option generally to go in or out of network, so be sure to find out what helmets are considered in network. From personal experience, BCBS of NJ was not able to tell me if it was covered without the official names of the helmets, but that may have been just the customer service rep I spoke with. I am not sure if this helps, but if I can be of any further assistance or support, please feel free to email me directly at jeannette.koizumi@... (I have a hard time following the posts. Jeannette NJ mom to (tort, plagio, DOC banded 3/11/04) --- In Plagiocephaly , " roguem22 " <MICHELLE@C...> wrote: > This is my first posting. My son is 5 months old and has > been diagnosed with plagio due to left tort. He was twin A in the > womb. His plagio is severe. I have BCBS of South Carolina PPO. Is > it going to be a problem to get approved for a band? Has anyone > been approved with this insurance company? The PT is going to take > measurements again this Friday and make a decision about the band. > > Any info would be appreciated. > > Thanks > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 8, 2004 Report Share Posted April 8, 2004 Hi, Thank you so much for answering me. the information was very helpful. my son's head is very flat in the back and widening on the sides. this causes a football kind of shape which make some of his physical therapy exercises difficult. He has a hard time turning his head side to side because has to get over the lump on each side. I am so glad I found this web site-- I don't feel so all alone now. I like the fact that so many of you are so upbeat about the bands. Have you seen any improvement in the last 4 weeks. Did you son have a problem getting used to it. Thanks, Original Message-----From: Jeannette Koizumi [mailto:jeannette.koizumi@...] Sent: Thursday, April 08, 2004 1:44 PMPlagiocephaly Subject: Re: Insurance question Hello,My son is 11 months old and was DOC banded 4 weeks ago for plagio due to right tort. I also have a BCBS product but here in NJ and had no trouble getting his band approved. However, as a former Benefits Analyst (quit my job 2 months ago), it isn't just the insurance company, but your specific plan that will determine whether it will be approved or not. My first recommendation is to go to your benefits office and ask for a SPD (summary plan description). By law, they have to provide this to you if requested. In there it should tell you what the plans coverage is for Durable Medical Goods. Orthodics will fall under that classification. If they cover Durable Medical Goods, you can then call BCBS and find out if if they cover it and what sort of authorization you will need. As a PPO, you have the option generally to go in or out of network, so be sure to find out what helmets are considered in network. From personal experience, BCBS of NJ was not able to tell me if it was covered without the official names of the helmets, but that may have been just the customer service rep I spoke with. I am not sure if this helps, but if I can be of any further assistance or support, please feel free to email me directly at jeannette.koizumi@... (I have a hard time following the posts.JeannetteNJ mom to (tort, plagio, DOC banded 3/11/04)> This is my first posting. My son is 5 months old and has > been diagnosed with plagio due to left tort. He was twin A in the > womb. His plagio is severe. I have BCBS of South Carolina PPO. Is > it going to be a problem to get approved for a band? Has anyone > been approved with this insurance company? The PT is going to take > measurements again this Friday and make a decision about the band.> > Any info would be appreciated.> > Thanks> For more plagio info Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 8, 2004 Report Share Posted April 8, 2004 Hi ! I see that Jeannette already posted some helpful info for you regarding insurance, so I just wanted to post and welcome you to the group! We have a lot of twins moms active in the group right now. Since 's plagio is severe, are you moving on ahead with getting a helmet or band? Is your PT the one evaluating his degree of asymmetry, or will you be going to a specialist or orthotist for some measurements eventually? We also have a lot of information on insurance issues here at the site. When you have time, browse around the files/insurance folder, and the links/insurance folder. Would you keep us posted on how the insurance is coming along, and how 's measurements go on Friday? Take care, Christie (Mom to Repo'd Remy) --- In Plagiocephaly , " roguem22 " <MICHELLE@C...> wrote: > This is my first posting. My son is 5 months old and has > been diagnosed with plagio due to left tort. He was twin A in the > womb. His plagio is severe. I have BCBS of South Carolina PPO. Is > it going to be a problem to get approved for a band? Has anyone > been approved with this insurance company? The PT is going to take > measurements again this Friday and make a decision about the band. > > Any info would be appreciated. > > Thanks > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 9, 2004 Report Share Posted April 9, 2004 Hi , Welcome to the group. We have BCBS of MA HMO and were denied for both DOCbands. We did choose to go out of state when we had in state options though. In the end, we did get BCBS to pay in full. Hannah was also severe and our neurosurgeon wrote a great letter of med necessity. I would think his severity would play in your favor in getting it covered. Good luck! , mom to Hannah, DOCband #3 3/30 Cape Cod, Ma --- In Plagiocephaly , " roguem22 " <MICHELLE@C...> wrote: > This is my first posting. My son is 5 months old and has > been diagnosed with plagio due to left tort. He was twin A in the > womb. His plagio is severe. I have BCBS of South Carolina PPO. Is > it going to be a problem to get approved for a band? Has anyone > been approved with this insurance company? The PT is going to take > measurements again this Friday and make a decision about the band. > > Any info would be appreciated. > > Thanks > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 9, 2004 Report Share Posted April 9, 2004 Hi! I just want to say good luck! We have BCBS of Texas PPO and we havent had any, but you never know what they are going to say. We just looked at it as our son had to have it even if they didnt cover it and they covered none. Good luck with your son! Rhiannon, Tx Bryce DOC Grad 2003 >From: " roguem22 " <MICHELLE@...> >Reply-Plagiocephaly >Plagiocephaly >Subject: Insurance question >Date: Thu, 08 Apr 2004 14:59:05 -0000 > >This is my first posting. My son is 5 months old and has >been diagnosed with plagio due to left tort. He was twin A in the >womb. His plagio is severe. I have BCBS of South Carolina PPO. Is >it going to be a problem to get approved for a band? Has anyone >been approved with this insurance company? The PT is going to take >measurements again this Friday and make a decision about the band. > >Any info would be appreciated. > >Thanks > > _________________________________________________________________ MSN Toolbar provides one-click access to Hotmail from any Web page – FREE download! http://toolbar.msn.com/go/onm00200413ave/direct/01/ Quote Link to comment Share on other sites More sharing options...
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