Guest guest Posted March 12, 2009 Report Share Posted March 12, 2009 Antonia - I forget where you are located. But Kaiser is different in different regions. WE have Kaiser in Southern California. Our band was covered at 80% - but we also had a special provision for DME. AND we had to go to the abnd that they said, not DOC, we had to use Hanger. We also had to jusmp thru their hoops - seeing their Cranio-facial team, fight for a rx, etc. I'm not saying it can't be done. It will just take some persistance on your part. And seeing how much you have doen to get your baby the 1st band I think you will do just fine!!! :-D Jen and Luli - 3 years old Left tort - Right Plagio - Hanger Band Grad - CA http://www.babiesonline.com/babies/j/jens5th/ I think... Well....I've come to accept this but I think Jayden will need another DOC band. I was hoping not since I have read stories about just weeks in the DOC band and parents have seen changes. There have been none in my sons case. Honestly I will take a second band, however.....I just simply do not know where I will get the money from. I had to get a loan for the first one and there is just no way to get a loan for another one. I hear Kaiser might cover this??? We have kaiser as a secondary insurance but I'm not exactly sure how it would work. Guess I would have to bill Anthem first and then send the denial to Kaiser. Sigh. It kind of just...oh sucks to think we might have another 16 weeks on our hands. Anyone have any luck with Kaiser paying for a DOC band after a child is one? Access 350+ FREE radio stations anytime from anywhere on the web. Get the Radio Toolbar! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 12, 2009 Report Share Posted March 12, 2009 Lol aw thanks. Yea I work for anthem so I know all about loop holes and certain things like that. I just hate the coordination of benefits thing. Hmmm. Well Kaiser, eh not sure cause its my ex husband that carries the insurance and unfortunately I know I won't get very far with him. But I will do whatever it takes for my son. While I'm not happy at the thought of a second band, I want myself and my son to not have any regrets later. I cannot let money get in the way of this no waySent via BlackBerry from T-MobileFrom: Jen Date: Fri, 13 Mar 2009 00:31:11 -0400<Plagiocephaly >Subject: Re: I think... Antonia - I forget where you are located. But Kaiser is different in different regions. WE have Kaiser in Southern California. Our band was covered at 80% - but we also had a special provision for DME. AND we had to go to the abnd that they said, not DOC, we had to use Hanger. We also had to jusmp thru their hoops - seeing their Cranio-facial team, fight for a rx, etc. I'm not saying it can't be done. It will just take some persistance on your part. And seeing how much you have doen to get your baby the 1st band I think you will do just fine!!! :-D Jen and Luli - 3 years old Left tort - Right Plagio - Hanger Band Grad - CA http://www.babiesonline.com/babies/j/jens5th/ I think... Well....I've come to accept this but I think Jayden will need another DOC band. I was hoping not since I have read stories about just weeks in the DOC band and parents have seen changes. There have been none in my sons case. Honestly I will take a second band, however.....I just simply do not know where I will get the money from. I had to get a loan for the first one and there is just no way to get a loan for another one. I hear Kaiser might cover this??? We have kaiser as a secondary insurance but I'm not exactly sure how it would work. Guess I would have to bill Anthem first and then send the denial to Kaiser. Sigh. It kind of just...oh sucks to think we might have another 16 weeks on our hands. Anyone have any luck with Kaiser paying for a DOC band after a child is one? Access 350+ FREE radio stations anytime from anywhere on the web. Get the Radio Toolbar! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 13, 2009 Report Share Posted March 13, 2009 Antonia, Kaiser paid for our 2 bands. The first one Maysa got, she was 9.5 months old. The second one she got, she was 12.5 months old. They covered it in full. Good luck! Leila Maysa, 13.5 months old, week 6 in DOC band 2 http://mymaysa.wordpress.com/--- On Thu, 3/12/09, Antonia <mommy2jaylina@...> wrote: From: Antonia <mommy2jaylina@...>Subject: I think...Plagiocephaly Date: Thursday, March 12, 2009, 10:22 PM Well....I've come to accept this but I think Jayden will need another DOC band. I was hoping not since I have read stories about just weeks in the DOC band and parents have seen changes. There have been none in my sons case. Honestly I will take a second band, however..... I just simply do not know where I will get the money from. I had to get a loan for the first one and there is just no way to get a loan for another one. I hear Kaiser might cover this??? We have kaiser as a secondary insurance but I'm not exactly sure how it would work. Guess I would have to bill Anthem first and then send the denial to Kaiser. Sigh. It kind of just...oh sucks to think we might have another 16 weeks on our hands. Anyone have any luck with Kaiser paying for a DOC band after a child is one? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 13, 2009 Report Share Posted March 13, 2009 By no means am I an expert on this, but here is what I just learned. I have an Anthem Blue Cross PPO Plan, and I just spoke with them the other day about coverage for my daughter positional plagiocephaly and was instructed to the following link: http://www.anthem.com/ca/medicalpolicies/policies/mp_pw_a050530.htm Under the heading " Position Statement " it lists the 4 criteria that must be met in order for them to cover the claim: 1. Patient is at least 3 months of age but not greater than 18 months of age; AND 2. Marked asymmetry has not been substantially improved following conservative therapy of at least 2 months duration with cranial repositioning therapy with or without physical therapy. Note: Due to the mobility of children > 4 months of age, repositioning therapy is not effective and thus, a trial of repositioning is not indicated; AND 3. Asymmetry of the cranial base as documented by any of the following: * Skull Base Asymmetry: At least 6 mm right/left discrepancy measured subnasally to the tip of the tragus (cartilaginous projection of the auricle at the front of the ear); or * Cranial Vault Asymmetry: At least a 8 mm right/left discrepancy, measured from the frontozygomaticus point (identified by palpation of the suture line above the upper outer corner of the orbit) to the contralateral euryon, defined as the most lateral point on the head located in the parietal region; or * Asymmetry of the orbitotragial distances, as documented by at least a 4 mm right/left asymmetry measured from the lateral aspect of orbit to tip of ipsilateral tragus. 4. The custom molded orthotic is designed to fit a child's head from 2-4 months. A second helmet or band may be required if the asymmetry has not resolved or significantly improved after 2-4 months. The Operator clarified item #2 for me, by explaining that if your child is greater than 4 months in age, repositioning therapy is believed to be not effective and thus you do not need to concern yourself with item #2. So in effect, if your child is between 4 months and 18 months and his/her asymmetry falls within one of the limits listed (Note that each Asymmetry item ends with the word " OR " ) then it is a covered claim. I also had a Cranial Technologies Insurance Rep independently confirm for us that our Band would be covered under our Anthem Blue Cross policy. Hope this is helpful .... > > Lol aw thanks. Yea I work for anthem so I know all about loop holes and certain things like that. I just hate the coordination of benefits thing. Hmmm. Well Kaiser, eh not sure cause its my ex husband that carries the insurance and unfortunately I know I won't get very far with him. But I will do whatever it takes for my son. While I'm not happy at the thought of a second band, I want myself and my son to not have any regrets later. I cannot let money get in the way of this no way > Sent via BlackBerry from T-Mobile > > I think... > > > > > > > Well....I've come to accept this but I think Jayden will need another DOC band. I was hoping not since I have read stories about just weeks in the DOC band and parents have seen changes. There have been none in my sons case. Honestly I will take a second band, however.....I just simply do not know where I will get the money from. I had to get a loan for the first one and there is just no way to get a loan for another one. I hear Kaiser might cover this??? We have kaiser as a secondary insurance but I'm not exactly sure how it would work. Guess I would have to bill Anthem first and then send the denial to Kaiser. Sigh. It kind of just...oh sucks to think we might have another 16 weeks on our hands. Anyone have any luck with Kaiser paying for a DOC band after a child is one? > Quote Link to comment Share on other sites More sharing options...
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