Re: Help with Claim - Blue Cross Blue Shield

[Guest guest]

Do not know much about BCBS or the specific plan in which you

are enrolled, but what was the reason that was given for the denial?

From: Plagiocephaly

[mailto:Plagiocephaly ] On Behalf Of robin.grey@...

Sent: Wednesday, March 25, 2009 10:55 AM

Plagiocephaly

Subject: Help with Claim - Blue Cross Blue Shield

Blue Cross Blue Shield denied our initial claim

for our helmet. We plan to appeal. Does anyone have a sample letter I could use

as a guide?? Any advice in the appeals process would be greatly appreciated.

Thanks in advance.

[Guest guest]

I have the Blue Cross Federal Plan, it was covered under Durable Medical

Equipment. we got 85% covered. Good luck

>

> Do not know much about BCBS or the specific plan in which you are enrolled,

> but what was the reason that was given for the denial?

>

>

>

> From: Plagiocephaly [mailto:Plagiocephaly ]

> On Behalf Of robin.grey@...

> Sent: Wednesday, March 25, 2009 10:55 AM

> Plagiocephaly

> Subject: Help with Claim - Blue Cross Blue Shield

>

>

>

> Blue Cross Blue Shield denied our initial claim for our helmet. We plan to

> appeal. Does anyone have a sample letter I could use as a guide?? Any advice

> in the appeals process would be greatly appreciated. Thanks in advance.

>

[Guest guest]

We have BCBS of KC. They also denied our daughter's band. We had an actual head remolding device exclusion in our contract. We appealed once and it was still denied. But many people have had succes at winning their appeals. Good luck!!!!!

Angie

Help with Claim - Blue Cross Blue Shield

Blue Cross Blue Shield denied our initial claim for our helmet. We plan to appeal. Does anyone have a sample letter I could use as a guide?? Any advice in the appeals process would be greatly appreciated. Thanks in advance.

[Guest guest]

They claim it is cosmetic, not a medical necessity.

>

> Do not know much about BCBS or the specific plan in which you are enrolled,

> but what was the reason that was given for the denial?

>

>

>

> From: Plagiocephaly [mailto:Plagiocephaly ]

> On Behalf Of robin.grey@...

> Sent: Wednesday, March 25, 2009 10:55 AM

> Plagiocephaly

> Subject: Help with Claim - Blue Cross Blue Shield

>

>

>

> Blue Cross Blue Shield denied our initial claim for our helmet. We plan to

> appeal. Does anyone have a sample letter I could use as a guide?? Any advice

> in the appeals process would be greatly appreciated. Thanks in advance.

>

[Guest guest]

I have BCBS in MA through Raytheon and its covered under durable medical equoment. From: "Duval" Date: Wed, 25 Mar 2009 11:49:09 -0700<Plagiocephaly >Subject: RE: Help with Claim - Blue Cross Blue Shield Do not know much about BCBS or the specific plan in which you are enrolled, but what was the reason that was given for the denial? From: Plagiocephaly [mailto:Plagiocephaly ] On Behalf Of robin.greyymailSent: Wednesday, March 25, 2009 10:55 AMPlagiocephaly Subject: Help with Claim - Blue Cross Blue Shield Blue Cross Blue Shield denied our initial claim for our helmet. We plan to appeal. Does anyone have a sample letter I could use as a guide?? Any advice in the appeals process would be greatly appreciated. Thanks in advance.

[Guest guest]

And the doctor won't write a letter of medical necessity for you? We have BCBS

federal employee program and ours was covered with a letter of medical

necessity.

Jake-2.5 (DOCBand Grad 9/08)

Jordan-5

> >

> > Do not know much about BCBS or the specific plan in which you are enrolled,

> > but what was the reason that was given for the denial?

> >

> >

> >

> > From: Plagiocephaly [mailto:Plagiocephaly ]

> > On Behalf Of robin.grey@

> > Sent: Wednesday, March 25, 2009 10:55 AM

> > Plagiocephaly

> > Subject: Help with Claim - Blue Cross Blue Shield

> >

> >

> >

> > Blue Cross Blue Shield denied our initial claim for our helmet. We plan to

> > appeal. Does anyone have a sample letter I could use as a guide?? Any advice

> > in the appeals process would be greatly appreciated. Thanks in advance.

> >

>

[Guest guest]

Hi ,

Which doctor wrote the letter of necessity for you? Was it your pediatrician?

We got our referral to CT through him, we never went to a specialist. We are

having problesm with BCBS in CA.

Thanks,

> > >

> > > Do not know much about BCBS or the specific plan in which you are

enrolled,

> > > but what was the reason that was given for the denial?

> > >

> > >

> > >

> > > From: Plagiocephaly [mailto:Plagiocephaly ]

> > > On Behalf Of robin.grey@

> > > Sent: Wednesday, March 25, 2009 10:55 AM

> > > Plagiocephaly

> > > Subject: Help with Claim - Blue Cross Blue Shield

> > >

> > >

> > >

> > > Blue Cross Blue Shield denied our initial claim for our helmet. We plan to

> > > appeal. Does anyone have a sample letter I could use as a guide?? Any

advice

> > > in the appeals process would be greatly appreciated. Thanks in advance.

> > >

> >

>

[Guest guest]

We saw a craniofacial surgeon who wrote the letter for us. I'm not sure I've

ever heard of a peditrician writing one, just cause they might not be as

knowledgable of the situation. The letter from our specialist detailed all the

possible problems that could occur if it was left untreated, it was 2 pages long

(pre-written with Jake's name and some specific details about him inserted).

Have you asked your ped for one? It wouldn't hurt to ask. All I do know is that

without it, we would not have gotten coverage, because it specifically stated in

the breakdown of coverage that one was required.

Jake-2.5 (DOCBand Grad 9/08)

Jordan-5

> > > >

> > > > Do not know much about BCBS or the specific plan in which you are

enrolled,

> > > > but what was the reason that was given for the denial?

> > > >

> > > >

> > > >

> > > > From: Plagiocephaly

[mailto:Plagiocephaly ]

> > > > On Behalf Of robin.grey@

> > > > Sent: Wednesday, March 25, 2009 10:55 AM

> > > > Plagiocephaly

> > > > Subject: Help with Claim - Blue Cross Blue Shield

> > > >

> > > >

> > > >

> > > > Blue Cross Blue Shield denied our initial claim for our helmet. We plan

to

> > > > appeal. Does anyone have a sample letter I could use as a guide?? Any

advice

> > > > in the appeals process would be greatly appreciated. Thanks in advance.

> > > >

> > >

> >

>

[Guest guest]

we had a letter of necessity written by a craniofacial specialist as well at

Cincinnati Childrens Hospital. We were referred there by our PT who we see for

torticollis.

Robin

SW Ohio

> > > >

> > > > Do not know much about BCBS or the specific plan in which you are

enrolled,

> > > > but what was the reason that was given for the denial?

> > > >

> > > >

> > > >

> > > > From: Plagiocephaly

[mailto:Plagiocephaly ]

> > > > On Behalf Of robin.grey@

> > > > Sent: Wednesday, March 25, 2009 10:55 AM

> > > > Plagiocephaly

> > > > Subject: Help with Claim - Blue Cross Blue Shield

> > > >

> > > >

> > > >

> > > > Blue Cross Blue Shield denied our initial claim for our helmet. We plan

to

> > > > appeal. Does anyone have a sample letter I could use as a guide?? Any

advice

> > > > in the appeals process would be greatly appreciated. Thanks in advance.

> > > >

> > >

> >

>

[Guest guest]

We never saw a specialist. But we are going to Rady Hospital in SD for physical

therapy for his torticollis. Should I ask them? CT told us a referral from our

pedi was fine to get coverage.

Thanks again for all your replies. It's very helpful.

> > > > >

> > > > > Do not know much about BCBS or the specific plan in which you are

enrolled,

> > > > > but what was the reason that was given for the denial?

> > > > >

> > > > >

> > > > >

> > > > > From: Plagiocephaly

[mailto:Plagiocephaly ]

> > > > > On Behalf Of robin.grey@

> > > > > Sent: Wednesday, March 25, 2009 10:55 AM

> > > > > Plagiocephaly

> > > > > Subject: Help with Claim - Blue Cross Blue Shield

> > > > >

> > > > >

> > > > >

> > > > > Blue Cross Blue Shield denied our initial claim for our helmet. We

plan to

> > > > > appeal. Does anyone have a sample letter I could use as a guide?? Any

advice

> > > > > in the appeals process would be greatly appreciated. Thanks in

advance.

> > > > >

> > > >

> > >

> >

>

[Guest guest]

Hi , I don't know if this will help you, but our insurance is through BCBS

and they are using the guidelines for insurance coverage that Anthem BCBS uses:

http://www.anthem.com/ca/medicalpolicies/policies/mp_pw_a050530.htm (there are

requirements and codes in the pdf file.)

I spoke to an insurance specialist about it and they told me that all the

requirements have to be fulfilled when a cranial orthosis is " reconstructive " .

He also told me that a letter from my son's pediatrician is required. So, I am

getting a letter of medical necessity that states all 4 requirements and going

to the orthotist tomorrow to get fitted. I'll post my insurance results.

Good Luck!

> > > > > >

> > > > > > Do not know much about BCBS or the specific plan in which you are

enrolled,

> > > > > > but what was the reason that was given for the denial?

> > > > > >

> > > > > >

> > > > > >

> > > > > > From: Plagiocephaly

[mailto:Plagiocephaly ]

> > > > > > On Behalf Of robin.grey@

> > > > > > Sent: Wednesday, March 25, 2009 10:55 AM

> > > > > > Plagiocephaly

> > > > > > Subject: Help with Claim - Blue Cross Blue Shield

> > > > > >

> > > > > >

> > > > > >

> > > > > > Blue Cross Blue Shield denied our initial claim for our helmet. We

plan to

> > > > > > appeal. Does anyone have a sample letter I could use as a guide??

Any advice

> > > > > > in the appeals process would be greatly appreciated. Thanks in

advance.

> > > > > >

> > > > >

> > > >

> > >

> >

>