Re: Blue Shield of California

[Guest guest]

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!

>