Guest guest Posted November 26, 2006 Report Share Posted November 26, 2006 Hi Kerry - I used my ped, who wrote us a letter of medical necessity which got us speech. Also, because you don't know the origins of the delay, perhaps some nice person would speculate if necessary...in utero stroke?? That's a trauma... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 26, 2006 Report Share Posted November 26, 2006 Hi Kerry - I used my ped, who wrote us a letter of medical necessity which got us speech. Also, because you don't know the origins of the delay, perhaps some nice person would speculate if necessary...in utero stroke?? That's a trauma... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 27, 2006 Report Share Posted November 27, 2006 we got our developmentally pediatrician who diagnosed him with Apraxia, Sensory Processing Disorder and Hypotonia to write a letter of medical necessity which they accepted and approved. Without it, they denied it. " athomegrant " <athomegrant@yaho o.com> To Sent by: childrensapraxian cc et@... m Subject [ ] insurance question 11/25/2006 06:35 PM Please respond to childrensapraxian et@... m Does anyone have any info for dealing with insurance companies and getting them to pay for speech services? I have a 3 1/2 year old boy who has apraxia. We did the EI route since he was 9 mos old and recently transferred to the public school system at three. His expressive speech is currently at a 15 month level. Tufts is telling us that the speech service is " not medically necessary since it is not caused by an injury or trauma " Any help on this would be greatly appreciated. Thanks, Kerry ----------------------------------------- This transmission may contain information that is privileged, confidential, legally privileged, and/or exempt from disclosure under applicable law. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or use of the information contained herein (including any reliance thereon) is STRICTLY PROHIBITED. Although this transmission and any attachments are believed to be free of any virus or other defect that might affect any computer system into which it is received and opened, it is the responsibility of the recipient to ensure that it is virus free and no responsibility is accepted by JP Chase & Co., its subsidiaries and affiliates, as applicable, for any loss or damage arising in any way from its use. If you received this transmission in error, please immediately contact the sender and destroy the material in its entirety, whether in electronic or hard copy format. Thank you. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 27, 2006 Report Share Posted November 27, 2006 we got our developmentally pediatrician who diagnosed him with Apraxia, Sensory Processing Disorder and Hypotonia to write a letter of medical necessity which they accepted and approved. Without it, they denied it. " athomegrant " <athomegrant@yaho o.com> To Sent by: childrensapraxian cc et@... m Subject [ ] insurance question 11/25/2006 06:35 PM Please respond to childrensapraxian et@... m Does anyone have any info for dealing with insurance companies and getting them to pay for speech services? I have a 3 1/2 year old boy who has apraxia. We did the EI route since he was 9 mos old and recently transferred to the public school system at three. His expressive speech is currently at a 15 month level. Tufts is telling us that the speech service is " not medically necessary since it is not caused by an injury or trauma " Any help on this would be greatly appreciated. Thanks, Kerry ----------------------------------------- This transmission may contain information that is privileged, confidential, legally privileged, and/or exempt from disclosure under applicable law. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or use of the information contained herein (including any reliance thereon) is STRICTLY PROHIBITED. Although this transmission and any attachments are believed to be free of any virus or other defect that might affect any computer system into which it is received and opened, it is the responsibility of the recipient to ensure that it is virus free and no responsibility is accepted by JP Chase & Co., its subsidiaries and affiliates, as applicable, for any loss or damage arising in any way from its use. If you received this transmission in error, please immediately contact the sender and destroy the material in its entirety, whether in electronic or hard copy format. Thank you. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 2, 2007 Report Share Posted February 2, 2007 hi, we paid upfront for both our docbands to get the discount. then i filed the paperwork myself. just make sure you follow your policy rules. we have to pre-notify UHC before we had casting done. we did this, then filed the paperwork. the first band was covered and the second band they denied. we eventually appealed second band and won. my advice is to call your insurance company at least once per week to see status of claim. i hope this helps. > > I was just wondering if any of you-all out there filed your own > insurance of left it up to a physician's office? Since you have to > pay up front for the bands I was wondering if the offices fought with > the insurance companies if there was a problem? Or if there is a > problem with the insurance do the doctors try once and then let you go > and flounder with the insurance companies? I have already had to call > the insurance company three times now and we don't even have the > initial paper work started . Any comments? Any one? > Thanks - Leanne > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 2, 2007 Report Share Posted February 2, 2007 I did not have to pay up front, but i definitely had to stay on top of the doctor's office about sending the necessary paperwork in and I followed up with the insurance company like everyday. I would suggest that you call the doctor's office everyday in order to check that their paperwork was sent to the insurance company. Then call the insurance company everyday to see if they received it. Then keep calling to see if you have been approved or denied. , NYvlwoodson <vlwoodson@...> wrote: I was just wondering if any of you-all out there filed your own insurance of left it up to a physician's office? Since you have to pay up front for the bands I was wondering if the offices fought with the insurance companies if there was a problem? Or if there is a problem with the insurance do the doctors try once and then let you go and flounder with the insurance companies? I have already had to call the insurance company three times now and we don't even have the initial paper work started . Any comments? Any one?Thanks - Leanne Finding fabulous fares is fun.Let FareChase search your favorite travel sites to find flight and hotel bargains. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 2, 2007 Report Share Posted February 2, 2007 Thanks to everyone in this group!!!! I have learned so much and you- all are so willing to share your experiences. We will do anything for our children...that's the way it should be. Thanks, Thanks, and more Thanks. New to it all. -Leanne Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 21, 2007 Report Share Posted May 21, 2007 appeal, appeal, appeal, sent letter of suport, Also sent a picture of your son with the letters. It help us we are now going to free Bed three a week.also United Health Care Children may help you. wendy <wendybird115@...> wrote: My son just turned 3 today and is officially out of Birth-3 services. We have a private SLP now and she of course wants to do the recommended 3-5 sessions per week. She sent the request to the insurance company for authorization (Anthem BCBS Husky of 10 visits from 5/21 to 7/23 and and they are denying any coverage. They state that the documentation provided does not support the criteria for short-term rehab under Husky B guidelines. So they are not stating that it's not medically neccessary, they are just saying they will not cover any of it because he needs it long-term. The special needs program in our state is going to cover one session a week...but that is it no matter what. He has the following diagnoses: Severe Childhood Apraxia of Speech, Oral Apraxia, Velopharyngeal Insufficiency of unknown etiology, and Autism Spectrum Disorder. They were covering 3-4 hours of speech a week provided by Birth-3 because Connecticut mandates insurance companies to cover Birth-3 services...now they are refusing to cover private because he won't be rehabilitated in a short period of time. Anyone else have denial for this reason? Anyone know what to do? Mazza Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 24, 2008 Report Share Posted January 24, 2008 this is so sad. Just one more reason to push for a national healthcare system of some kind. I don't have any experience or knowledge about this, but it is wrong that you even have to worry about this. -christine sydney 2 yrs starband grad > > I'm new here, posted yesterday about my 4 month old daughter who may > need a band. We have private insurance which means that the insurance > company can raise our rates or kick us off the insurance whenever they > feel like it. For this reason, we try not to report things to the > insurance unless we have to. My daughters physical therapy we just pay > for, etc... So far we havent had any problems even though we did report > my maternity bills, the kids well and sick visits, etc... but I'm > wondering if anyone has any experience with having reported a > band/helmet to insurance and them covering it, but then kicking you > off, or raising your rates. If we decide to go ahead with the band, we > are considering just paying for it to avoid losing our insurance. (My > husband is self employed). Has anyone ever heard of this happening > before? > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 24, 2008 Report Share Posted January 24, 2008 I agree, my husband and I were talking just recently about how lucky we are that we can afford to do the band, and how sad it is that the health and well being of our children are in the hands of a bunch of old farts pluging away at calculators in thier offices. And I believe that I saw on this list recently that Medicare never covers the band... If you haven't seen "Sicko" you should. I'll get off my soap box now. Kami Kiley 3 Keenan 5 months Doc band 3 weekschristineashok <christineashok@...> wrote: this is so sad. Just one more reason to push for a national healthcaresystem of some kind. I don't have any experience or knowledge aboutthis, but it is wrong that you even have to worry about this.-christinesydney 2 yrs starband grad>> I'm new here, posted yesterday about my 4 month old daughter who may > need a band. We have private insurance which means that the insurance > company can raise our rates or kick us off the insurance whenever they > feel like it. For this reason, we try not to report things to the > insurance unless we have to. My daughters physical therapy we just pay > for, etc... So far we havent had any problems even though we did report > my maternity bills, the kids well and sick visits, etc... but I'm > wondering if anyone has any experience with having reported a > band/helmet to insurance and them covering it, but then kicking you > off, or raising your rates. If we decide to go ahead with the band, we > are considering just paying for it to avoid losing our insurance. (My > husband is self employed). Has anyone ever heard of this happening > before?> Be a better friend, newshound, and know-it-all with Mobile. Try it now. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 30, 2008 Report Share Posted December 30, 2008 > > My youngest daughter recently got her helmet. Our insurance compnay, > Blue Cross/Blue Shield of New England paid for 80% of the cost and we > paid for 20%. How can I get my insurance company to pay for the entire > 100%? How can I appeal this? My oldest daughter needed a helmet as well > and the insurance company paid for it in full back in 2006. (I am > aware that I am lucky our insurance co. will pay for any portion, it's > just very hard for my husband and I fiancially right now.) Any advice > and information would be greatly appreciated! > I am sorry to say that getting the insurance company to pay for any more is probably not going to happen. Most of the time, the amount (if any) they pay is determined by the contract the insurance co.has with your insurance provider(employer). For example, when I had my children, our insurance company pays 90% and we are responsible for the other 10%. I would see about talking with the company providing the helmet to see if they can offer you some kind of hardship discount. In my case, my insurance paid 100%. However, they only paid $550 towards the helmet, but the contract my insurance co. has requires the provider to accept insurance payment in full and to write off the rest. If your insurance company is paying $1000, your insurance payment alone is going to be more the my insurance payment in full. So, the helmet provider may be more likely to work with you in decreasing your out of pocket expense b/c they are being better compensated. I hope I am not confusing you too much! Good luck! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 30, 2008 Report Share Posted December 30, 2008 You're right, you're lucky that the insurance company is paying for such a large portion of the band. Did the policy change which would explain why one year they covered 100% and this year they only covered 80%? I think it will depend upon the policy whether or not you can appeal it. Our policy flat out said that Durable Medical Equipment (DME), which the band was considered to be, was covered at 80% so there wasn't anything to appeal with that. I would check the specifics of your policy and see if you can figure out where the 80% figure came from. Molly Novato, California Nicolas, 3, tort & plagio, STARband (CIRS Oakland) 4/24/06-9/12/06, Graduate! , 5.5 , 9 Insurance Question My youngest daughter recently got her helmet. Our insurance compnay, Blue Cross/Blue Shield of New England paid for 80% of the cost and we paid for 20%. How can I get my insurance company to pay for the entire 100%? How can I appeal this? My oldest daughter needed a helmet as well and the insurance company paid for it in full back in 2006. (I am aware that I am lucky our insurance co. will pay for any portion, it's just very hard for my husband and I fiancially right now.) Any advice and information would be greatly appreciated! ------------------------------------ For more plagio info Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 30, 2008 Report Share Posted December 30, 2008 >How did you get for BCBS to pay for 80%? BCBS of North Carolina denied my son's claim. > My youngest daughter recently got her helmet. Our insurance compnay, > Blue Cross/Blue Shield of New England paid for 80% of the cost and we > paid for 20%. How can I get my insurance company to pay for the entire > 100%? How can I appeal this? My oldest daughter needed a helmet as well > and the insurance company paid for it in full back in 2006. (I am > aware that I am lucky our insurance co. will pay for any portion, it's > just very hard for my husband and I fiancially right now.) Any advice > and information would be greatly appreciated! > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 30, 2008 Report Share Posted December 30, 2008 I have blue cross blue shield and they paid the whole claim from hanger with a 170 deductibleSent via BlackBerry from T-MobileFrom: "kimbailey_03" Date: Tue, 30 Dec 2008 20:13:18 -0000<Plagiocephaly >Subject: Re: Insurance Question >How did you get for BCBS to pay for 80%? BCBS of North Carolina denied my son's claim. > My youngest daughter recently got her helmet. Our insurance compnay, > Blue Cross/Blue Shield of New England paid for 80% of the cost and we > paid for 20%. How can I get my insurance company to pay for the entire > 100%? How can I appeal this? My oldest daughter needed a helmet as well > and the insurance company paid for it in full back in 2006. (I am > aware that I am lucky our insurance co. will pay for any portion, it's > just very hard for my husband and I fiancially right now.) Any advice > and information would be greatly appreciated! > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 30, 2008 Report Share Posted December 30, 2008 You need to check your individual contract. We have BCBS of Kansas City HMO. We have an actual head remolding device exclusion. Having said that appeal appeal appeal. If that doesn't work, I know some members have gone to their employers benefits and got help that way. Good Luck. Angie Re: Insurance Question >How did you get for BCBS to pay for 80%? BCBS of North Carolina denied my son's claim.> My youngest daughter recently got her helmet. Our insurance compnay, > Blue Cross/Blue Shield of New England paid for 80% of the cost and we > paid for 20%. How can I get my insurance company to pay for the entire > 100%? How can I appeal this? My oldest daughter needed a helmet as well > and the insurance company paid for it in full back in 2006. (I am > aware that I am lucky our insurance co. will pay for any portion, it's > just very hard for my husband and I fiancially right now.) Any advice > and information would be greatly appreciated!> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 24, 2009 Report Share Posted April 24, 2009 Hi! We JUST got done dealing with this EXACT same thing with the same insurance. Your story sounds so similar to mine. Our son also had the plagio from lack of space in the womb. Email me and I can answer any specific questions you have. - MKE17@... > > We have BCBS of CA and they keep dragging their feet on our claim for our Doc Band. Now they want us to give documentation of having tried repositioning by parents or PT or a statement indicating why repositioning is not practical. Has anyone had to do this? If so, what are they specifically looking for? We tried repositioning for 3 months and was unsuccessful. In fact, we've been told he got it from the lack of space in the womb b/c he was so severe. Our ped told us we had to go to CT b/c his head was so bad. He was 24 mm for plagio and 96% for brachy. I know the Doc Band works b/c his brachy is at 86% and 15 mm for his plagio after his first band. > > Thanks for your replies! > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 26, 2009 Report Share Posted April 26, 2009 Hi, Our doctor wrote a letter of medical necessity to our insurance claiming that we had tried repositioning for 2 months without the results needed to correct my daughter's plagio. Our claim got paid on the first try. Good luck! From: ellianagrace <MKE17@...>Subject: Re: Insurance QuestionPlagiocephaly Date: Friday, April 24, 2009, 10:33 PM Hi! We JUST got done dealing with this EXACT same thing with the same insurance. Your story sounds so similar to mine. Our son also had the plagio from lack of space in the womb. Email me and I can answer any specific questions you have. - MKE17hotmail (DOT) com>> We have BCBS of CA and they keep dragging their feet on our claim for our Doc Band. Now they want us to give documentation of having tried repositioning by parents or PT or a statement indicating why repositioning is not practical. Has anyone had to do this? If so, what are they specifically looking for? We tried repositioning for 3 months and was unsuccessful. In fact, we've been told he got it from the lack of space in the womb b/c he was so severe. Our ped told us we had to go to CT b/c his head was so bad. He was 24 mm for plagio and 96% for brachy. I know the Doc Band works b/c his brachy is at 86% and 15 mm for his plagio after his first band. > > Thanks for your replies!> > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 23, 2010 Report Share Posted June 23, 2010 Does anyone use AETNA as an insurer? If so any luck getting them to cover OT and speech therapy? I am starting an appeal process and would appreciate any hints. Thanks, Bruneau Sent from my iPhone Quote Link to comment Share on other sites More sharing options...
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