Re: Oh those crazy insurance people...!

[Guest guest]

Good for you!!!

Shook

Retail Operations Manager/Baking Instructor

Vie de France Yamazaki, Inc.

2070 Chain Bridge Rd. Suite 500

Vienna, VA 22182

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fax

[Guest guest]

,

Was this for the s or the Markells? I'm trying to find out

where I stand with Aetna covering s for Livi... they said

today that the billing code for the shoes was covered, but the billing

code for the brace was only covered if she was diabetic. What did you

have to do/what steps did you take? That is, if you are talking about

the s...

Any advice you can give would help - trying to figure out what

sequence I need to take each step and no one seems to know. Between

coordinating the doctor's office, the orthotics department, and the

insurance company, I'm overwhelmed.

THanks!

Darby

> Just a followup...I think I posted about the trouble I was having

> getting our ins. to pay for Ava's new shoes. They said no because

she

> wasn't diabetic & it wasn't an integral part of a leg brace & I said

> you're crazy she needs this you must pay for it and the ortho shop

> said they said no, too bad and I called AGAIN and said PAY FOR IT

DARN

> YOU!!! Anyhoo...got a message from the brace shop " Oh, everything's

> working out, Aetna said they'll cover it " I have 50% DME coverage.

> Ortho place called again and said " Oh her shoes are in, can you come

> Friday? " Sure, says I, and do I pay my 50% when I pick them up? " Oh,

> no, " says the ortho lady, YOUR INSURANCE COMPANY PAID THE WHOLE

> THING!!!!! Uh, huh. Well, like they say, our's is not to reason why,

> ours is to take the shoes and RUN!!!

> , mommy of:

> Guinevere, harrison, Ava 8/4/04 ABS RCF FAB 18/7 (in her new FREE

> shoes!)

[Guest guest]

Darby,

I think that code may be primarily based on Medicaid insurance codes. Not

sure, but I do know that 's experience with Medicaid in Iowa (might be

called something else for that state) was with those codes. I can't

imagine much reason why diabetes would come into play with this, unless the

part he uses that makes the shoes eligible as AFO's is geared more toward

diabetics. That's just speculation on my part though, I may be totally

wrong on all this. At any rate, perhaps the code is associated with

diabetes somehow or maybe Medicaid could shed some light on exactly why

diabetes would be an issue at all. Try calling the insurance advocates in

WA, it should be in the phone book. Ask them to look into the code and

what other codes might be available that are the same thing.

no fun... but it'll come! Of course we assume no baby since you're

posting... patiently waiting down here :~} Wouldn't be if I were you!

Kori

At 08:37 PM 5/9/2005, you wrote:

>,

>

>Was this for the s or the Markells? I'm trying to find out

>where I stand with Aetna covering s for Livi... they said

>today that the billing code for the shoes was covered, but the billing

>code for the brace was only covered if she was diabetic. What did you

>have to do/what steps did you take? That is, if you are talking about

>the s...

>

>Any advice you can give would help - trying to figure out what

>sequence I need to take each step and no one seems to know. Between

>coordinating the doctor's office, the orthotics department, and the

>insurance company, I'm overwhelmed.

>

>THanks!

>

>Darby

>

> > Just a followup...I think I posted about the trouble I was having

> > getting our ins. to pay for Ava's new shoes. They said no because

>she

> > wasn't diabetic & it wasn't an integral part of a leg brace & I said

> > you're crazy she needs this you must pay for it and the ortho shop

> > said they said no, too bad and I called AGAIN and said PAY FOR IT

>DARN

> > YOU!!! Anyhoo...got a message from the brace shop " Oh, everything's

> > working out, Aetna said they'll cover it " I have 50% DME coverage.

> > Ortho place called again and said " Oh her shoes are in, can you come

> > Friday? " Sure, says I, and do I pay my 50% when I pick them up? " Oh,

> > no, " says the ortho lady, YOUR INSURANCE COMPANY PAID THE WHOLE

> > THING!!!!! Uh, huh. Well, like they say, our's is not to reason why,

> > ours is to take the shoes and RUN!!!

> > , mommy of:

> > Guinevere, harrison, Ava 8/4/04 ABS RCF FAB 18/7 (in her new FREE

> > shoes!)

>

>

>

>

>

>

[Guest guest]

Kori,

I guess the codes (got them from someone on this board) are universal

insurance codes and I verified this with the s...and aetna

covers the code for the shoes, just not the brace. There is something

in their policy that talks about bracing only being appropriate for

diabetics - of course I plan to appeal this one. Aetna says I need a

" pre-determination " and that the docs know how to do that. Well my

doc office had no idea what I was talking about when I mentioned it to

them.... grrr... I just hope I can get this resolved BEFORE the baby

decides to come. I didn't know there were such things as insurance

advocates. Great suggestion - I will look into that.

And NO I'm not patiently waiting for the baby!!!! I'm getting so

grumpy you wouldn't believe... I'm HUGE!!!!!

Can't wait to see my own feet again.

Darby

Livi 3.15.04 bi cf

ALICIA DUE IN 2 DAYS!!!!

> > > Just a followup...I think I posted about the trouble I was having

> > > getting our ins. to pay for Ava's new shoes. They said no because

> >she

> > > wasn't diabetic & it wasn't an integral part of a leg brace & I said

> > > you're crazy she needs this you must pay for it and the ortho shop

> > > said they said no, too bad and I called AGAIN and said PAY FOR IT

> >DARN

> > > YOU!!! Anyhoo...got a message from the brace shop " Oh, everything's

> > > working out, Aetna said they'll cover it " I have 50% DME coverage.

> > > Ortho place called again and said " Oh her shoes are in, can you come

> > > Friday? " Sure, says I, and do I pay my 50% when I pick them up? " Oh,

> > > no, " says the ortho lady, YOUR INSURANCE COMPANY PAID THE WHOLE

> > > THING!!!!! Uh, huh. Well, like they say, our's is not to reason why,

> > > ours is to take the shoes and RUN!!!

> > > , mommy of:

> > > Guinevere, harrison, Ava 8/4/04 ABS RCF FAB 18/7 (in her new FREE

> > > shoes!)

> >

> >

> >

> >

> >

> >

[Guest guest]

nosurgery4clubfoot , " frogabog "

wrote:

> Darby,

>

> I think that code may be primarily based on Medicaid insurance

codes. Not

> sure, but I do know that 's experience with Medicaid in Iowa

(might be

> called something else for that state) was with those codes. I can't

> imagine much reason why diabetes would come into play with this,

unless the

> part he uses that makes the shoes eligible as AFO's is geared more

toward

> diabetics. That's just speculation on my part though, I may be totally

> wrong on all this. At any rate, perhaps the code is associated with

> diabetes somehow or maybe Medicaid could shed some light on exactly why

> diabetes would be an issue at all. Try calling the insurance

advocates in

> WA, it should be in the phone book. Ask them to look into the code and

> what other codes might be available that are the same thing.

>

> no fun... but it'll come! Of course we assume no baby since you're

> posting... patiently waiting down here :~} Wouldn't be if I were you!

>

> Kori

>

>

>

>

>

> At 08:37 PM 5/9/2005, you wrote:

> >,

> >

> >Was this for the s or the Markells? I'm trying to find out

> >where I stand with Aetna covering s for Livi... they said

> >today that the billing code for the shoes was covered, but the billing

> >code for the brace was only covered if she was diabetic. What did you

> >have to do/what steps did you take? That is, if you are talking about

> >the s...

> >

> >Any advice you can give would help - trying to figure out what

> >sequence I need to take each step and no one seems to know. Between

> >coordinating the doctor's office, the orthotics department, and the

> >insurance company, I'm overwhelmed.

> >

> >THanks!

> >

> >Darby

> >

> > > Just a followup...I think I posted about the trouble I was having

> > > getting our ins. to pay for Ava's new shoes. They said no because

> >she

> > > wasn't diabetic & it wasn't an integral part of a leg brace & I said

> > > you're crazy she needs this you must pay for it and the ortho shop

> > > said they said no, too bad and I called AGAIN and said PAY FOR IT

> >DARN

> > > YOU!!! Anyhoo...got a message from the brace shop " Oh, everything's

> > > working out, Aetna said they'll cover it " I have 50% DME coverage.

> > > Ortho place called again and said " Oh her shoes are in, can you come

> > > Friday? " Sure, says I, and do I pay my 50% when I pick them up? " Oh,

> > > no, " says the ortho lady, YOUR INSURANCE COMPANY PAID THE WHOLE

> > > THING!!!!! Uh, huh. Well, like they say, our's is not to reason why,

> > > ours is to take the shoes and RUN!!!

> > > , mommy of:

> > > Guinevere, harrison, Ava 8/4/04 ABS RCF FAB 18/7 (in her new FREE

> > > shoes!)

> >

> >

> >

> >

> >

> >

[Guest guest]

Darby,

I've had quite a bit of experience dealing with insurance companies,

and if you have the patience, keep calling back at the insurance

company until you find someone who is willing to really listen to

you, and who can be your personal representative. I have Medica, so

I can't give you the name of the person I deal with exclusively, but

that's what I ended up doing.

After dealing with my husband's 2 heart surgeries, his seizure, and

now a cyst he has to have removed, plus Aleksander's premature birth

and his clubfoot, I've learned how to manipulate the system quite

well.

If you reach someone who seems intelligent and seems to really care

about their job, get their number and ask them if the doctor's office

can contact them to arrange the documentation. If they aren't

willing to do that, ask them if there is someone else you can talk to

who can help.

Also, my best advice is to stay calm, play up your situation (the

fact that you are due any minute), and kiss their butt as much as

possible at first. If/when the butt kissing doesn't get you

anywhere, then you can get tough and ask for someone else until you

get someone who will actually do their job properly and CARE about

your situation.

Who knows, this may be good stress relief. I sometimes enjoy it!

But if it stresses you too much, ask for help. If I can help at all,

just shoot me an e-mail. I seriously do enjoy putting the screws to

the insurance companies. They are so corrupt and resist paying for

the things we are insured for!

kannhoudek@...

> > > > Just a followup...I think I posted about the trouble I was

having

> > > > getting our ins. to pay for Ava's new shoes. They said no

because

> > >she

> > > > wasn't diabetic & it wasn't an integral part of a leg brace &

I said

> > > > you're crazy she needs this you must pay for it and the ortho

shop

> > > > said they said no, too bad and I called AGAIN and said PAY

FOR IT

> > >DARN

> > > > YOU!!! Anyhoo...got a message from the brace shop " Oh,

everything's

> > > > working out, Aetna said they'll cover it " I have 50% DME

coverage.

> > > > Ortho place called again and said " Oh her shoes are in, can

you come

> > > > Friday? " Sure, says I, and do I pay my 50% when I pick them

up? " Oh,

> > > > no, " says the ortho lady, YOUR INSURANCE COMPANY PAID THE

WHOLE

> > > > THING!!!!! Uh, huh. Well, like they say, our's is not to

reason why,

> > > > ours is to take the shoes and RUN!!!

> > > > , mommy of:

> > > > Guinevere, harrison, Ava 8/4/04 ABS RCF FAB 18/7 (in her new

FREE

> > > > shoes!)

> > >

> > >

> > >

> > >

> > >

> > >

[Guest guest]

Thanks !

I'll see what the doctors office says today, then it's back on the

phone with the insurance. I'll do what you say and find a nice caring

rep to be my " friend " and go to bat for me. In some sort of sick and

twisted way, I secretly like doing this too... that way I have

something to occupy my time instead of brooding about whether or not

I'm in labor!

Darby

> > > > > Just a followup...I think I posted about the trouble I was

> having

> > > > > getting our ins. to pay for Ava's new shoes. They said no

> because

> > > >she

> > > > > wasn't diabetic & it wasn't an integral part of a leg brace

&

> I said

> > > > > you're crazy she needs this you must pay for it and the

ortho

> shop

> > > > > said they said no, too bad and I called AGAIN and said PAY

> FOR IT

> > > >DARN

> > > > > YOU!!! Anyhoo...got a message from the brace shop " Oh,

> everything's

> > > > > working out, Aetna said they'll cover it " I have 50% DME

> coverage.

> > > > > Ortho place called again and said " Oh her shoes are in, can

> you come

> > > > > Friday? " Sure, says I, and do I pay my 50% when I pick them

> up? " Oh,

> > > > > no, " says the ortho lady, YOUR INSURANCE COMPANY PAID THE

> WHOLE

> > > > > THING!!!!! Uh, huh. Well, like they say, our's is not to

> reason why,

> > > > > ours is to take the shoes and RUN!!!

> > > > > , mommy of:

> > > > > Guinevere, harrison, Ava 8/4/04 ABS RCF FAB 18/7 (in her

new

> FREE

> > > > > shoes!)

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

[Guest guest]

,

Yes, run!, before they change their minds! Glad everything worked out for you.

redskline123@...> wrote:

Just a followup...I think I posted about the trouble I was having

getting our ins. to pay for Ava's new shoes. They said no because she

wasn't diabetic & it wasn't an integral part of a leg brace & I said

you're crazy she needs this you must pay for it and the ortho shop

said they said no, too bad and I called AGAIN and said PAY FOR IT DARN

YOU!!! Anyhoo...got a message from the brace shop " Oh, everything's

working out, Aetna said they'll cover it " I have 50% DME coverage.

Ortho place called again and said " Oh her shoes are in, can you come

Friday? " Sure, says I, and do I pay my 50% when I pick them up? " Oh,

no, " says the ortho lady, YOUR INSURANCE COMPANY PAID THE WHOLE

THING!!!!! Uh, huh. Well, like they say, our's is not to reason why,

ours is to take the shoes and RUN!!!

, mommy of:

Guinevere, harrison, Ava 8/4/04 ABS RCF FAB 18/7 (in her new FREE

shoes!)

[Guest guest]

Darby,

Sorry it took so long to respond, it's been crazy lately...anyway,

Ava is in the Markells. But I think the biggest thing is to keep

calling the ins. co. until you get a cust. svc rep (or whatever

they're called) that HAS A BRAIN!!!! The first few times I called,

the people obviously had no CLUE what I was talking about (I must

admit, I was so frustrated by the last lady I purposely began

talking circles around her--you know, throwing terms like " tenotomy "

and " FAB " and " talipes " around...hehe) They were obviously reading

from a book or computer or whatever, and didn't understand the

situation. All they can do is parrot back what the book says " unless

she has diabetes or it's an integral part of a leg brace no foot

braces are covered " AAARRRGGGGHHH!!!! I finally got a REALLY nice

lady, who totally understood what I needed (she said her nephew had

a clubfoot 20 some years ago) and worked on the situation for me.

That being said, we did get the Markells, not the s, but I

saw on the statement from the ortho place that they billed it as a

foot abd. BAR...so who knows? The stmnt is in the car, which is in

for a " checkup " right now, but if you'd like I'll check it when I

get it back & see if there's any more info I can give you.

Hope this helps!

> > Just a followup...I think I posted about the trouble I was

having

> > getting our ins. to pay for Ava's new shoes. They said no

because

> she

> > wasn't diabetic & it wasn't an integral part of a leg brace & I

said

> > you're crazy she needs this you must pay for it and the ortho

shop

> > said they said no, too bad and I called AGAIN and said PAY FOR

IT

> DARN

> > YOU!!! Anyhoo...got a message from the brace shop " Oh,

everything's

> > working out, Aetna said they'll cover it " I have 50% DME

coverage.

> > Ortho place called again and said " Oh her shoes are in, can you

come

> > Friday? " Sure, says I, and do I pay my 50% when I pick them

up? " Oh,

> > no, " says the ortho lady, YOUR INSURANCE COMPANY PAID THE WHOLE

> > THING!!!!! Uh, huh. Well, like they say, our's is not to reason

why,

> > ours is to take the shoes and RUN!!!

> > , mommy of:

> > Guinevere, harrison, Ava 8/4/04 ABS RCF FAB 18/7 (in her new

FREE

> > shoes!)