Insurance paid 90% of P/Ms!!

[Guest guest]

We received great news yesterday. Our insurance

company, United Healthcare, paid 90% of the cost

of Lily's Ponseti/ FAB without a fight.

What a relief. Hopefully this is a sign that

at least some of the insurance companies are

getting " a clue. "

Kim

Lily, 3/28/05, lcf, P/M FAB 23/7

Tessa, 7/17/2002

[Guest guest]

Ours paid 100%! We were thrilled. We had to fight the claim once and that was

it.

Chris

Insurance paid 90% of P/Ms!!

We received great news yesterday. Our insurance

company, United Healthcare, paid 90% of the cost

of Lily's Ponseti/ FAB without a fight.

What a relief. Hopefully this is a sign that

at least some of the insurance companies are

getting " a clue. "

Kim

Lily, 3/28/05, lcf, P/M FAB 23/7

Tessa, 7/17/2002

[Guest guest]

Kim-

That's so awesome! I bet you were all prepared to fight!

Congratulations!

> We received great news yesterday. Our insurance

> company, United Healthcare, paid 90% of the cost

> of Lily's Ponseti/ FAB without a fight.

> What a relief. Hopefully this is a sign that

> at least some of the insurance companies are

> getting " a clue. "

>

> Kim

> Lily, 3/28/05, lcf, P/M FAB 23/7

> Tessa, 7/17/2002

[Guest guest]

Hello,

I have United as well and they just denied my claim for the DBB and

shoes for the second time! This is ridiculous. This is my daughter's

third pair of shoes and second bar, and they have paid the past two

times. However, we switched hospitals as we moved from Atlanta to

Seattle, so we're wondering if Children's Hospital here in Seattle

billed it wrong or something.

Does anyone know if there is a special way the shoes and bar should be

billed to the insurance company?

Thanks!

> We received great news yesterday. Our insurance

> company, United Healthcare, paid 90% of the cost

> of Lily's Ponseti/ FAB without a fight.

> What a relief. Hopefully this is a sign that

> at least some of the insurance companies are

> getting " a clue. "

>

> Kim

> Lily, 3/28/05, lcf, P/M FAB 23/7

> Tessa, 7/17/2002

[Guest guest]

-

Typically it helps if the code that is used translates into " durable

medical equipment " . Our insurance company rejected the shoes the

first billing period because the code the hospital used didn't

translate into a recognizable item for our insurance company. Once

the hospital explained what it was for, they paid the bill.

Hope this helps!

Kathleen

> > We received great news yesterday. Our insurance

> > company, United Healthcare, paid 90% of the cost

> > of Lily's Ponseti/ FAB without a fight.

> > What a relief. Hopefully this is a sign that

> > at least some of the insurance companies are

> > getting " a clue. "

> >

> > Kim

> > Lily, 3/28/05, lcf, P/M FAB 23/7

> > Tessa, 7/17/2002

[Guest guest]

Hi, ,

I looked at our " Explanation of Benefits " from United

for Lily's first pair of Markells & DBB. Unfortunately

it doesn't say what code the hospital used to bill United.

It just lists them as " medical supplies. " I know this

isn't much help. Maybe you could call the hospital in

Atlanta & they could tell you how they used to bill United?

Sounds like it's just a mixup... Hope it gets straightened

out without a lot of time on your part!

Kim

> > We received great news yesterday. Our insurance

> > company, United Healthcare, paid 90% of the cost

> > of Lily's Ponseti/ FAB without a fight.

> > What a relief. Hopefully this is a sign that

> > at least some of the insurance companies are

> > getting " a clue. "

> >

> > Kim

> > Lily, 3/28/05, lcf, P/M FAB 23/7

> > Tessa, 7/17/2002

[Guest guest]

,

I have had some experience with Children's orthotics department here

in Seattle.... most likely they billed it correctly - it's your

insurance company not knowing their policy well enough to process

it. What was the reason for the denial?

I can't stand Children's Orthotics dept., but they have always billed

our DBB correctly (prior to us switching to the p/m fab). We have

Aetna - United Health Care has always seemed much nicer than Aetna

for these things. Keep calling and emailing them until you get the

answer you want! I had best results with getting Aetna to do what I

wanted by using their " Contact us " form on the website... I think it

helped for me to provide info in writing so they could research it,

vs. putting me on hold and not doing thorough research for fear of

keeping me on hold for too long.

Good luck!

Darby

Livi bi cf 3.15.04 p/m fab 16/7

> > We received great news yesterday. Our insurance

> > company, United Healthcare, paid 90% of the cost

> > of Lily's Ponseti/ FAB without a fight.

> > What a relief. Hopefully this is a sign that

> > at least some of the insurance companies are

> > getting " a clue. "

> >

> > Kim

> > Lily, 3/28/05, lcf, P/M FAB 23/7

> > Tessa, 7/17/2002

[Guest guest]

Thanks for the advice. I called UHC today - again - and they are

going to pay the claim now. I had to explain to her that the shoes

and bar are used together and there is no use for the shoes without

the bar as well. They did use the code for durable medical

equipment, but I guess it shows up as shoes, which are not covered.

She told me I will probably have to go through this every time we

get new shoes. What a pain. Children's Healthcare of Atlanta was

sooooo much easier to deal with.

On ANOTHER issue with Children's Orthotics here in Seattle - they

billed our office visit with Dr. Mosca as " Outpatient-Hospital

Setting, " instead of an office visit - so they are telling me the

standard Specialist Copay doesn't apply, and the charges go toward

my deductible! It's all because Dr. Mosca's practice is actually

located in the hosptial instead of a separate office! I can't get

anyone at Children's to bill this properly, they state they have

billed this correctly. ERRRRRR!!!! Any suggestions on dealing

with them???

Thanks!

> > > We received great news yesterday. Our insurance

> > > company, United Healthcare, paid 90% of the cost

> > > of Lily's Ponseti/ FAB without a fight.

> > > What a relief. Hopefully this is a sign that

> > > at least some of the insurance companies are

> > > getting " a clue. "

> > >

> > > Kim

> > > Lily, 3/28/05, lcf, P/M FAB 23/7

> > > Tessa, 7/17/2002

[Guest guest]

Thanks for the advice. I called UHC today - again - and they are

going to pay the claim now. I had to explain to her that the shoes

and bar are used together and there is no use for the shoes without

the bar as well. They did use the code for durable medical

equipment, but I guess it shows up as shoes, which are not covered.

She told me I will probably have to go through this every time we

get new shoes. What a pain. Children's Healthcare of Atlanta was

sooooo much easier to deal with.

On ANOTHER issue with Children's Orthotics here in Seattle - they

billed our office visit with Dr. Mosca as " Outpatient-Hospital

Setting, " instead of an office visit - so they are telling me the

standard Specialist Copay doesn't apply, and the charges go toward

my deductible! It's all because Dr. Mosca's practice is actually

located in the hosptial instead of a separate office! I can't get

anyone at Children's to bill this properly, they state they have

billed this correctly. ERRRRRR!!!! Any suggestions on dealing

with them???

Thanks!

> > > We received great news yesterday. Our insurance

> > > company, United Healthcare, paid 90% of the cost

> > > of Lily's Ponseti/ FAB without a fight.

> > > What a relief. Hopefully this is a sign that

> > > at least some of the insurance companies are

> > > getting " a clue. "

> > >

> > > Kim

> > > Lily, 3/28/05, lcf, P/M FAB 23/7

> > > Tessa, 7/17/2002

[Guest guest]

We had a similar thing happen with Gillette here. I ended up

calling until I found someone who would take the time to listen, and

now I have her name and direct line should this happen again. That

is what I could suggest.

I had to explain that although the facility is a hospital, we were

going to a clinic located within the hospital. We were only going

for an office visit and that the only place the doctor practiced out

of was Gillette, or some other area clinics they considered

hospitals.

I can't recommend enough that once you find a good and meticulous

representative that you get their name and number. It helps tons

not ot have to explain yourself every time you have to call to have

something fixed.

Good luck!

> > > > We received great news yesterday. Our insurance

> > > > company, United Healthcare, paid 90% of the cost

> > > > of Lily's Ponseti/ FAB without a fight.

> > > > What a relief. Hopefully this is a sign that

> > > > at least some of the insurance companies are

> > > > getting " a clue. "

> > > >

> > > > Kim

> > > > Lily, 3/28/05, lcf, P/M FAB 23/7

> > > > Tessa, 7/17/2002

[Guest guest]

,

My suggestion for Seattle Children's Orthotics- go somewhere else!!!

I was going to look into this before, but now that I'm using the

s instead, I no longer have to see them. There must be other

orthotics places around Seattle - may dr. mosca would be willing to

actually write you an rx for what you need next time instead of just

sending you downstairs to orthotics.

They really were so unhelpful when I was trying to get my s -

all I wanted them to do was order the shoes for me and bill the

insurance - it would have made the whole insurance/affordability

factor so much better. But they decided they didn't like the billing

code the mitchells were using, and were determined to use one that

would make the insurance pay LESS. Then they said they would have to

double the cost from $382 to $750, and because of the billing code

think, I would have had to pay about $600 for this $382 pair of

shoes! They wanted to charge me double just for placing an order -

no work required on their part at all.

This was after mentioning the brace to the orthotist and

getting laughed off multiple times.

Good luck! I would really look into getting your fab somewhere else

if it's possible, even though it's so convenient to get it at

Children's.

Darby

Livi 3.15.04 bi cf p/m fab 16/7

> > > > > We received great news yesterday. Our insurance

> > > > > company, United Healthcare, paid 90% of the cost

> > > > > of Lily's Ponseti/ FAB without a fight.

> > > > > What a relief. Hopefully this is a sign that

> > > > > at least some of the insurance companies are

> > > > > getting " a clue. "

> > > > >

> > > > > Kim

> > > > > Lily, 3/28/05, lcf, P/M FAB 23/7

> > > > > Tessa, 7/17/2002