Getting insurance to pay for the Ponseti/ brace

[Guest guest]

,

Maddening is definitely an understatement for dealing with insurance

companies. I wish I could help you out but I am paying through the roof for

insurance and it seems like more and more things are not covered. What is

the point of insurance anyway!?!?! I hate them all....sorry...needed to be

said.

I hope you find a way to get the insurance to pay.

Getting insurance to pay for the

Ponseti/ brace

Hi all,

Any tips on getting BCBS PPO to pay (or any ins. for that matter)

for the Ponseti/ brace? Our ins. is denying it because they

now tell me I was supposed to obtain it through an orthotic supplier

and not a doctor's office. Isn't an orthotist? I sure

thought he was. And doesn't my doctor know what is best for my son?

This is just maddening. I'm not sure what to do, but I do know that I

don't have $380.00 for each time my son grows out of the shoes. (We

tried the Markells and they did not work for us). Any info would be

very helpful. Thank you.

3/28/01 perfect feet

3/1/05 one club foot

[Guest guest]

,

Maddening is definitely an understatement for dealing with insurance

companies. I wish I could help you out but I am paying through the roof for

insurance and it seems like more and more things are not covered. What is

the point of insurance anyway!?!?! I hate them all....sorry...needed to be

said.

I hope you find a way to get the insurance to pay.

Getting insurance to pay for the

Ponseti/ brace

Hi all,

Any tips on getting BCBS PPO to pay (or any ins. for that matter)

for the Ponseti/ brace? Our ins. is denying it because they

now tell me I was supposed to obtain it through an orthotic supplier

and not a doctor's office. Isn't an orthotist? I sure

thought he was. And doesn't my doctor know what is best for my son?

This is just maddening. I'm not sure what to do, but I do know that I

don't have $380.00 for each time my son grows out of the shoes. (We

tried the Markells and they did not work for us). Any info would be

very helpful. Thank you.

3/28/01 perfect feet

3/1/05 one club foot

[Guest guest]

Hi all,

Any tips on getting BCBS PPO to pay (or any ins. for that matter)

for the Ponseti/ brace? Our ins. is denying it because they

now tell me I was supposed to obtain it through an orthotic supplier

and not a doctor's office. Isn't an orthotist? I sure

thought he was. And doesn't my doctor know what is best for my son?

This is just maddening. I'm not sure what to do, but I do know that I

don't have $380.00 for each time my son grows out of the shoes. (We

tried the Markells and they did not work for us). Any info would be

very helpful. Thank you.

3/28/01 perfect feet

3/1/05 one club foot

[Guest guest]

Hi all,

Any tips on getting BCBS PPO to pay (or any ins. for that matter)

for the Ponseti/ brace? Our ins. is denying it because they

now tell me I was supposed to obtain it through an orthotic supplier

and not a doctor's office. Isn't an orthotist? I sure

thought he was. And doesn't my doctor know what is best for my son?

This is just maddening. I'm not sure what to do, but I do know that I

don't have $380.00 for each time my son grows out of the shoes. (We

tried the Markells and they did not work for us). Any info would be

very helpful. Thank you.

3/28/01 perfect feet

3/1/05 one club foot

[Guest guest]

Hi ,

My insurance has ALWAYS covered, I carry BCBS Alternative PPO and I've never had

a problem. In fact, the first pair of /Ponseti shoes I purchased were

350 and my insurance reimbursed me for partial due to my deductible. This is

hardware and it's for the treatment of your child. That's all they need to

know.

I can't recall if is an orthotist, I don't think that he is. However,

he now uses Hangar to process his claims for him -

Technically, your shoes are coming from a supplier. If I were you, I would have

(he's very accommodating) write you a note stating on his stationary that

these shoes are a medical necessity for the treatment of your child. Also, have

Joyce, Dr. Ponseti's assistant give you a note that states that. I recall I had

to go through the letter processing.

The other thing to keep in mind is that you should pay a partial price for the

shoes, since the bar grows with your child. Lhea (my daughter) has gone through

3 pairs. The first pair was 350, the 2nd was a shoe upgrade since her feet

outgrew her first shoes and same thing for the 3rd pair.

Good luck.

Jennipher

Mommy to Lhea, born with BCF 5/28/04

jlkittredge wrote:

Hi all,

Any tips on getting BCBS PPO to pay (or any ins. for that matter)

for the Ponseti/ brace? Our ins. is denying it because they

now tell me I was supposed to obtain it through an orthotic supplier

and not a doctor's office. Isn't an orthotist? I sure

thought he was. And doesn't my doctor know what is best for my son?

This is just maddening. I'm not sure what to do, but I do know that I

don't have $380.00 for each time my son grows out of the shoes. (We

tried the Markells and they did not work for us). Any info would be

very helpful. Thank you.

3/28/01 perfect feet

3/1/05 one club foot

[Guest guest]

Hi ,

My insurance has ALWAYS covered, I carry BCBS Alternative PPO and I've never had

a problem. In fact, the first pair of /Ponseti shoes I purchased were

350 and my insurance reimbursed me for partial due to my deductible. This is

hardware and it's for the treatment of your child. That's all they need to

know.

I can't recall if is an orthotist, I don't think that he is. However,

he now uses Hangar to process his claims for him -

Technically, your shoes are coming from a supplier. If I were you, I would have

(he's very accommodating) write you a note stating on his stationary that

these shoes are a medical necessity for the treatment of your child. Also, have

Joyce, Dr. Ponseti's assistant give you a note that states that. I recall I had

to go through the letter processing.

The other thing to keep in mind is that you should pay a partial price for the

shoes, since the bar grows with your child. Lhea (my daughter) has gone through

3 pairs. The first pair was 350, the 2nd was a shoe upgrade since her feet

outgrew her first shoes and same thing for the 3rd pair.

Good luck.

Jennipher

Mommy to Lhea, born with BCF 5/28/04

jlkittredge wrote:

Hi all,

Any tips on getting BCBS PPO to pay (or any ins. for that matter)

for the Ponseti/ brace? Our ins. is denying it because they

now tell me I was supposed to obtain it through an orthotic supplier

and not a doctor's office. Isn't an orthotist? I sure

thought he was. And doesn't my doctor know what is best for my son?

This is just maddening. I'm not sure what to do, but I do know that I

don't have $380.00 for each time my son grows out of the shoes. (We

tried the Markells and they did not work for us). Any info would be

very helpful. Thank you.

3/28/01 perfect feet

3/1/05 one club foot

[Guest guest]

My advice - keep talking to different people at BCBS until someone

gives you the answer you want to hear!

It took me many phone calls and emails to get Aetna to pay for the

s... but eventually I was able to get them to see things my

way. It all depends on who you talk to. I know Aetna has things

called " Clinical Policy Bulletins " that are determinations on what

their policies do/don't cover. Maybe if BCBS has those online you can

search through them and find some determinations to support your claim.

If the problem is only w/ the s as a provider, there may be a

different way. With my claim, MD Orthopaedic wasn't in the Aetna

system, so I asked Jean to call Aetna to get added. Maybe it would be

the same w/ BCBS - if MD Orthopaedic calls in a gives them

documentation of what kind of service they provide, it might work....

you need to ask why they think that MD Orthopaedic is not an orthotics

provider (they are), and what to do to rectify it. Talk to a

supervisor!!!

Good luck!

Darby

Livi bi cf p/m fab 16/7

> Hi all,

> Any tips on getting BCBS PPO to pay (or any ins. for that matter)

> for the Ponseti/ brace? Our ins. is denying it because they

> now tell me I was supposed to obtain it through an orthotic supplier

> and not a doctor's office. Isn't an orthotist? I sure

> thought he was. And doesn't my doctor know what is best for my son?

> This is just maddening. I'm not sure what to do, but I do know that

I

> don't have $380.00 for each time my son grows out of the shoes. (We

> tried the Markells and they did not work for us). Any info would be

> very helpful. Thank you.

>

>

>

> 3/28/01 perfect feet

> 3/1/05 one club foot

[Guest guest]

My advice - keep talking to different people at BCBS until someone

gives you the answer you want to hear!

It took me many phone calls and emails to get Aetna to pay for the

s... but eventually I was able to get them to see things my

way. It all depends on who you talk to. I know Aetna has things

called " Clinical Policy Bulletins " that are determinations on what

their policies do/don't cover. Maybe if BCBS has those online you can

search through them and find some determinations to support your claim.

If the problem is only w/ the s as a provider, there may be a

different way. With my claim, MD Orthopaedic wasn't in the Aetna

system, so I asked Jean to call Aetna to get added. Maybe it would be

the same w/ BCBS - if MD Orthopaedic calls in a gives them

documentation of what kind of service they provide, it might work....

you need to ask why they think that MD Orthopaedic is not an orthotics

provider (they are), and what to do to rectify it. Talk to a

supervisor!!!

Good luck!

Darby

Livi bi cf p/m fab 16/7

> Hi all,

> Any tips on getting BCBS PPO to pay (or any ins. for that matter)

> for the Ponseti/ brace? Our ins. is denying it because they

> now tell me I was supposed to obtain it through an orthotic supplier

> and not a doctor's office. Isn't an orthotist? I sure

> thought he was. And doesn't my doctor know what is best for my son?

> This is just maddening. I'm not sure what to do, but I do know that

I

> don't have $380.00 for each time my son grows out of the shoes. (We

> tried the Markells and they did not work for us). Any info would be

> very helpful. Thank you.

>

>

>

> 3/28/01 perfect feet

> 3/1/05 one club foot

[Guest guest]

,

We are in the same boat. We have Federal BCBS and I am sending to them the

following documentation as they request in their Benefit booklet. A

Prescription from the doctor, a letter of medical necessity, invoicing from

's which I got since I requested the impression kit in order to have the

shoes made and will let you know what I hear.

, mom to , 11 weeks BL CF, currently Markell/DBB (not working)

jlkittredge wrote:

Hi all,

Any tips on getting BCBS PPO to pay (or any ins. for that matter)

for the Ponseti/ brace? Our ins. is denying it because they

now tell me I was supposed to obtain it through an orthotic supplier

and not a doctor's office. Isn't an orthotist? I sure

thought he was. And doesn't my doctor know what is best for my son?

This is just maddening. I'm not sure what to do, but I do know that I

don't have $380.00 for each time my son grows out of the shoes. (We

tried the Markells and they did not work for us). Any info would be

very helpful. Thank you.

3/28/01 perfect feet

3/1/05 one club foot

[Guest guest]

,

We are in the same boat. We have Federal BCBS and I am sending to them the

following documentation as they request in their Benefit booklet. A

Prescription from the doctor, a letter of medical necessity, invoicing from

's which I got since I requested the impression kit in order to have the

shoes made and will let you know what I hear.

, mom to , 11 weeks BL CF, currently Markell/DBB (not working)

jlkittredge wrote:

Hi all,

Any tips on getting BCBS PPO to pay (or any ins. for that matter)

for the Ponseti/ brace? Our ins. is denying it because they

now tell me I was supposed to obtain it through an orthotic supplier

and not a doctor's office. Isn't an orthotist? I sure

thought he was. And doesn't my doctor know what is best for my son?

This is just maddening. I'm not sure what to do, but I do know that I

don't have $380.00 for each time my son grows out of the shoes. (We

tried the Markells and they did not work for us). Any info would be

very helpful. Thank you.

3/28/01 perfect feet

3/1/05 one club foot