Insurance Appeal

[Guest guest]

I am having issues with our insurance paying for the helmet. I

called after seeing our physician back in March and the Customer

Service told me that the helmet just started being covered January

2006. So I called our Orthotist and told them. The office manager

then called our insurance to double check and they told her that it

was not covered unless they had the fused skull. We knew that we

couldn't put a price on our son's head and health, so we got the

helmet. The day of the fitting the office manager at the orthotic

clinic called them again. This time asked specifically if this

diagnosis code was covered and she said yes, that it just started

being covered in Janauary. We got the helmet the end of April and he

is a week from getting it off now and I just got a bill saying that

they aren't paying. The orthotic office sent a letter with her

documentation and the insurance sent one back saying that an oral

statement can't modify or otherwise affect the benefits,

limitations, and exclusions of the policy.

So, My question is, what is my next step. I am with Blue Cross Blue

Shield federal employee plan. Can anyone help me?

Thanks