BCBS Federal Program Basic Option - Any success stories?

[Guest guest]

, I have BCBS through the Federal Employee Program as well however it appears that you have the standard option. Is that correct? I have the basic option so I don't believe they will cover it. For basic option if it is out of network they cover zero. I'm bummed but I am going to file the claim and dispute it when they don't pay for it. There aren't any cranial specialists in our plan that are in-network. Any suggestions? Anyone out there have success with getting reimbursed from BCBS of NJ, Federal Program, Basic Option? Thanks for the help, Sybilnwilkens2275 <nwilkens2275@...> wrote: Yes I had a similar experience. I have BCBS of North Carolina Federal Employee Program (through the government). The helmet was covered under the plan, it just depended whether I went to an in-network (90% would be covered) or out-of-network (75%) provider. I wanted to go to Cranial Tech, but they were considered out-of-network. I spoke to an insurance specialist out of the Charlotte office. She told me that because they were out of network, that they would not be able to file the claim for me and that I would have to pay up front ($3000) and file the claim myself. I was okay with that. She then told me that her experience has been that BCBS of NC only covers about $600 before the deductible (which is $300), so she said I should expect

to only get 75% of $300. I was totally bummed and expecting the worst. So I filed the claim and after about 3 weeks we got a check for $2073, exactly 75% of $2700 (and some odd dollars since we had paid a little towards our deductible). In the insurance specialist's defense, the federal employee plan is different than your basic BCBS, and she had never dealt with the plan before. But I'm thrilled that her prediction turned out to be so wrong. One of the many things I've learned from this whole plagio journey is not to take everything you're told as an absolute truth. I would recommend ALWAYS filing a claim with your insurance even if you're told it won't be covered. Jake-18m (tort resolved/rt plagio/DocBand 7 weeks)>> > > Okay, so my

hubby and I were not the most organized when it comes to our insurance. > Our 4 month daughter had plagiocephaly with right tort. Our doctor recommend we go to > Cranial Tech. for a consultation and least get some neck exercises. We went but not right > away because I was in denial and she had so much hair you couldn't really tell. So we went > and about a month later get got the DOC Band. The insurance specialist with Cranial Tech > said they would check into our insurance and came back to us and said Blue Shield would > not cover it. So we payed up front 3,000 dollars. When we went for Kaylee's 6 month > check at her doctors. Kaylee's doctor couldn't believe I had to pay for the Band and said I > should have told her and she could have recommend another place. I talked to the > insurance girl at > the doctors and she said to write a letter for medical necessity

so I did. The insurance also > did not want to pay for a doctors visit we had talking to the doctor about if they thought > we should go through with the DOC band. They said it was a preexisting condition that > we didn't tell them about when we switched insurances when she was two months old. > Well we got a letter back saying > they would pay for the doctors visit and The DOC Band and we just needed to turn a > receipt in and make a claim. I talked to Cranial Tech and they said Blue Shield has never > payed for a DOC Band. When we called our insurance lady yesterday she said the check > has been issued and we don't even need to make claim. This is so strange!!!! Has > anyone else had this experience? Wow we are super excited to get the 3,000 dollars back. > But we are not holding our breath! > > , mommy of Kaylee, DOC Band for 8

weeks!>

You rock. That's why Blockbuster's offering you one month of Blockbuster Total Access, No Cost.

[Guest guest]

Hi Sybil-

Correct, I do have the standard option. I didn't realize the

coverage was zero for out-of-network under the basic option. It

doesn't seem fair that there would be coverage for the band in the

plan but no in-network providers in your area. Maybe if they deny

it, you can appeal on that basis? I'm sorry, I wish I had a really

good suggestion for you. Good luck with the claim! Please keep me

posted on the result.

Jake-18m (tort resolved/rt plagio/DocBand 7 weeks)

Jordan-4

> >

> >

> >

> > Okay, so my hubby and I were not the most organized when it

comes

> to our insurance.

> > Our 4 month daughter had plagiocephaly with right tort. Our

> doctor recommend we go to

> > Cranial Tech. for a consultation and least get some neck

> exercises. We went but not right

> > away because I was in denial and she had so much hair you

couldn't

> really tell. So we went

> > and about a month later get got the DOC Band. The insurance

> specialist with Cranial Tech

> > said they would check into our insurance and came back to us and

> said Blue Shield would

> > not cover it. So we payed up front 3,000 dollars. When we went

> for Kaylee's 6 month

> > check at her doctors. Kaylee's doctor couldn't believe I had to

> pay for the Band and said I

> > should have told her and she could have recommend another place.

> I talked to the

> > insurance girl at

> > the doctors and she said to write a letter for medical necessity

> so I did. The insurance also

> > did not want to pay for a doctors visit we had talking to the

> doctor about if they thought

> > we should go through with the DOC band. They said it was a

> preexisting condition that

> > we didn't tell them about when we switched insurances when she

was

> two months old.

> > Well we got a letter back saying

> > they would pay for the doctors visit and The DOC Band and we

just

> needed to turn a

> > receipt in and make a claim. I talked to Cranial Tech and they

> said Blue Shield has never

> > payed for a DOC Band. When we called our insurance lady

yesterday

> she said the check

> > has been issued and we don't even need to make claim. This is so

> strange!!!! Has

> > anyone else had this experience? Wow we are super excited to get

> the 3,000 dollars back.

> > But we are not holding our breath!

> >

> > , mommy of Kaylee, DOC Band for 8 weeks!

> >

>

>

>

>

>

>

> ---------------------------------

> You rock. That's why Blockbuster's offering you one month of

Blockbuster Total Access, No Cost.

>