First Denial - Blue Cross of California

[Guest guest]

Hi All,

After about 4 months, we finally heard that our son's helmet was denied

coverage. Did

anyone else feel like taking it personally? I was so angry with the whole

process...how the

doctor's told us to plan on it not being covered, made us pay in full, and gave

us the run-

around about filing paperwork. Nobody wants to even submit anything because they

want to

make sure they are getting paid.

Of course we are on the way to filing our first appeal, it's just so

frustrating...!

Thanks for letting me vent,

[Guest guest]

I completely agree. The Orthopedic office would not file our claim they just told us it wasn't a covered item. When the finally filed it we were already finished with the treatment. And we filed our fist appeal and the insurance company stated that it isn't a covered item. My appeal that it was medically necessary didn't work the insurance company stated the helmet is an excluded item. I am not sure were to go from here. I am going to get a copy of my policy to see if I can find any loop holes but I am not feeling good about our second appeal. The insurance company stated we could only appeal this item twice so I know we only have one last chance. We have BCBS of Kansas, but live in SC. If anyone has any information they could help me with it would be greatly appreciated. Amy mom of River 15 months and Ruby 2 weeks. <kjm412@...>

wrote: Hi All, After about 4 months, we finally heard that our son's helmet was denied coverage. Did anyone else feel like taking it personally? I was so angry with the whole process...how the doctor's told us to plan on it not being covered, made us pay in full, and gave us the run-around about filing paperwork. Nobody wants to even submit anything because they want to make sure they are getting paid.Of course we are on the way to filing our first appeal, it's just so frustrating...!Thanks for letting me

vent,

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

[Guest guest]

What was their reason for denial? Who is your provider? CT is in network in CA.

[Guest guest]

What provider did you use and do you happen to know if it's covered in KS? We

are in SC, used a NC provider and have CA insurance. A portion was covered

because it was filed in CA instead of SC or NC.

[Guest guest]

This is strange, The place we went to in No. Cal said

that Blue Cross Requires a syrtain percentage of

Assymetry and they put it all together for us and told

us to turn it in for a claim, and we also included the

Rx for the helmet from our neurologist. We just

submitted it so not sure if they will pay or deny, but

the place we went to said they are usually pretty good

about paying. Oh and they only pay for plagio not

brachy (stupid). I will be interested to see what they

do.

Marina

--- shyde@... wrote:

> What was their reason for denial? Who is your

> provider? CT is in network in CA.

>

________________________________________________________________________________\

____

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

Access, No Cost.

http://tc.deals./tc/blockbuster/text5.com

[Guest guest]

I have BCBS of KC - and according to our policy it is 90% covered I am still on 1st appeal atm. They also told the doctors office it was covered as your policy states. Will keep everyone posted there 60dys is almost up.

Re: First Denial - Blue Cross of California

I completely agree. The Orthopedic office would not file our claim they just told us it wasn't a covered item. When the finally filed it we were already finished with the treatment. And we filed our fist appeal and the insurance company stated that it isn't a covered item. My appeal that it was medically necessary didn't work the insurance company stated the helmet is an excluded item. I am not sure were to go from here. I am going to get a copy of my policy to see if I can find any loop holes but I am not feeling good about our second appeal. The insurance company stated we could only appeal this item twice so I know we only have one last chance. We have BCBS of Kansas, but live in SC. If anyone has any information they could help me with it would be greatly appreciated.

Amy mom of River 15 months

and Ruby 2 weeks. <kjm412 (DOT) com> wrote:

Hi All, After about 4 months, we finally heard that our son's helmet was denied coverage. Did anyone else feel like taking it personally? I was so angry with the whole process...how the doctor's told us to plan on it not being covered, made us pay in full, and gave us the run-around about filing paperwork. Nobody wants to even submit anything because they want to make sure they are getting paid.Of course we are on the way to filing our first appeal, it's just so frustrating. ..!Thanks for letting me vent,

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

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

[Guest guest]

The insurance " specialist " didn't even know all the details, couldn't pronounce

" plagiocephaly "

(not that I blame him really) and said he'll be sending us the paperwork.

The problem is we live in Tennessee and not in California. The BC is continued

Cobra

coverage from my last job. So we paid $1300/month for family insurance coverage

while my

husband and I were unemployed only to get NOTHING covered (so far)!!!!

>

> What was their reason for denial? Who is your provider? CT is in network in

CA.

>

[Guest guest]

hopefully at least some coverage will come through. goodluck to you!

[Guest guest]

We used starband, but from the letter we recieved from the insurance company it made it seem as any provider wouldn't be covered that this type of item is excluded from our plan. And from what I understand is that if we have BCBS of Kansas but claim is filed in SC then they go by SC coverage. I am not sure of this though I am still checking on these things. If anyone from SC know of starband being covered on BCBS could you tell me how it was filed? I am wondering if the ortho office filed it correctly. Thanks for any help!! Amyshyde@... wrote: What provider did you use and do you happen to know if it's covered in KS? We are in SC, used a NC provider and have CA insurance. A portion was covered because it was filed in CA instead of SC or NC.

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

[Guest guest]

Yeah, the insurance initially acts like it " might " happen. In fact, we were more

hopeful after

submitting the claim that it would be covered than we were after speaking to the

doctor

and billing department! But they didn't say anything about a percentage but are

sending

us a letter with the details. Apparently it doesn't matter what kind of helmet

is used. they

don't see it as " medically necessary " . Living in TN and having insurance from

California

might be a problem but the insurance said they didn't think it would be the

issue. The

issue is the necessity of the helmet!

>

> > What was their reason for denial? Who is your

> > provider? CT is in network in CA.

> >

>

>

>

>

________________________________________________________________________________\

____

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

Access,

No Cost.

> http://tc.deals./tc/blockbuster/text5.com

>

[Guest guest]

Is BCBS saying they WOULD cover it if you had a letter of medical

necessity from the doctor? Or are they not covering it at all,

regardless if you have the letter or not? I have BCBS of NC (federal

employee program, which is a little different than standard BCBS)

and they required a letter of medical necessity for it to be

covered. If I did not have that, it would have been denied. If you

haven't provided them with a letter yet, you could try to include it

in your appeal (if that is next step for you).

Good luck!

Jake-19m (tort resolved/rt plagio/DOCBand 7 weeks)

Jordan-4

> >

> > > What was their reason for denial? Who is your

> > > provider? CT is in network in CA.

> > >

> >

> >

> >

> >

>

_____________________________________________________________________

_______________

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

Blockbuster Total Access,

> No Cost.

> > http://tc.deals./tc/blockbuster/text5.com

> >

>