Guest guest Posted April 21, 2005 Report Share Posted April 21, 2005 When we had BCBS they covered 90% of my sons HBO. Rita Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 26, 2005 Report Share Posted April 26, 2005 Was it hard for you to get coverage or is it an automatic thing with this insurance company? Since we own our own business we can pretty much get any insurance company we want and I might look into that...The only thing is that I would want to know about the lifetime max on that insurance..I will need to find out.. Thanks Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 4, 2009 Report Share Posted June 4, 2009 Has anyone had to go through the appeal process with BCBS? My daughter Jenna just got her helmet yesterday, and although we haven't gotten a denail letter yet, we've been told from the orthotist that it will be denied based on their past experience with BCBS. She has been in physical therapy for torticollis for about 2 months. She will be 8 months on June 8th. The whole appeal process just seems so overwhelming to me and I'm not sure I have the time/energy to deal with it--Jenna is a twin and I also have another girl who just turned 2 in May. My life is a little busy! Thanks for the help! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 4, 2009 Report Share Posted June 4, 2009 i'm in the same exact boat--bcbs allowed us to submit our claim--no promise to pay. they asked for photos yeterday, which i sent. who knows where this will go-- Betsy From: sarahjries <sarahjries@...>Subject: BCBS coveragePlagiocephaly Date: Thursday, June 4, 2009, 10:27 AM Has anyone had to go through the appeal process with BCBS? My daughter Jenna just got her helmet yesterday, and although we haven't gotten a denail letter yet, we've been told from the orthotist that it will be denied based on their past experience with BCBS. She has been in physical therapy for torticollis for about 2 months. She will be 8 months on June 8th. The whole appeal process just seems so overwhelming to me and I'm not sure I have the time/energy to deal with it--Jenna is a twin and I also have another girl who just turned 2 in May. My life is a little busy! Thanks for the help! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 5, 2009 Report Share Posted June 5, 2009 I am in the process of appealing BCBS's denial of our claim. Their reasoning was that the treatment was not medically necessary. They will only cover the helmet AFTER surgery. I fail to see the logic. I thought the appeal process would be overwhelming too, considering the amount of information that was available but here's what I did. I looked at our policy's definition of " medically necessary " and I addressed each part of that definition, illustrating why my son's treatment did indeed meet the definition. I included copies of the Rx for his PT and his helmet. I had letters of medical necessity from both our doctor and the PT. ( did PT and repo for about 12 weeks before we got the helmet.) I also sent copies of his records from the orthotist showing the asymmetry and his progress. (He went from 12mm to 1mm in 10 weeks with the helmet.) At any rate, I was supposed to receive my answer within 30 days and so far it has been 45 days. I've been told BCBS has consulted with an outside specialist and that is what has caused the delay. I'll let you know how it comes out. -- , mom to 2 and 9 mo (STARband grad 4/15/09) On Thu, Jun 4, 2009 at 8:56 AM , sarahjries wrote: > Has anyone had to go through the appeal process with BCBS? My daughter > Jenna just got her helmet yesterday, and although we haven't gotten a > denail letter yet, we've been told from the orthotist that it will be > denied based on their past experience with BCBS. She has been in > physical therapy for torticollis for about 2 months. She will be 8 > months on June 8th. The whole appeal process just seems so > overwhelming to me and I'm not sure I have the time/energy to deal > with it--Jenna is a twin and I also have another girl who just turned > 2 in May. My life is a little busy! Thanks for the help! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 5, 2009 Report Share Posted June 5, 2009 Cinga is the same way. They said they would only cover the helmet post surgery. What the heck?? It’s pretty stupid. For now we’re not going to get the helmet and try repositioning and hope it gets better. From: Plagiocephaly [mailto:Plagiocephaly ] On Behalf Of Ahlstedt Sent: Friday, June 05, 2009 9:06 AM Plagiocephaly Subject: RE: BCBS coverage I am in the process of appealing BCBS's denial of our claim. Their reasoning was that the treatment was not medically necessary. They will only cover the helmet AFTER surgery. I fail to see the logic. I thought the appeal process would be overwhelming too, considering the amount of information that was available but here's what I did. I looked at our policy's definition of " medically necessary " and I addressed each part of that definition, illustrating why my son's treatment did indeed meet the definition. I included copies of the Rx for his PT and his helmet. I had letters of medical necessity from both our doctor and the PT. ( did PT and repo for about 12 weeks before we got the helmet.) I also sent copies of his records from the orthotist showing the asymmetry and his progress. (He went from 12mm to 1mm in 10 weeks with the helmet.) At any rate, I was supposed to receive my answer within 30 days and so far it has been 45 days. I've been told BCBS has consulted with an outside specialist and that is what has caused the delay. I'll let you know how it comes out. -- , mom to 2 and 9 mo (STARband grad 4/15/09) On Thu, Jun 4, 2009 at 8:56 AM , sarahjries wrote: > Has anyone had to go through the appeal process with BCBS? My daughter > Jenna just got her helmet yesterday, and although we haven't gotten a > denail letter yet, we've been told from the orthotist that it will be > denied based on their past experience with BCBS. She has been in > physical therapy for torticollis for about 2 months. She will be 8 > months on June 8th. The whole appeal process just seems so > overwhelming to me and I'm not sure I have the time/energy to deal > with it--Jenna is a twin and I also have another girl who just turned > 2 in May. My life is a little busy! Thanks for the help! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 6, 2009 Report Share Posted June 6, 2009 We got full coverage, we only had to pay 15%. We have the BCBS Federal Employee plan. I think the plans vary from state to state. Good luck! Robin SW Ohio > > Has anyone had to go through the appeal process with BCBS? My daughter Jenna just got her helmet yesterday, and although we haven't gotten a denail letter yet, we've been told from the orthotist that it will be denied based on their past experience with BCBS. She has been in physical therapy for torticollis for about 2 months. She will be 8 months on June 8th. The whole appeal process just seems so overwhelming to me and I'm not sure I have the time/energy to deal with it--Jenna is a twin and I also have another girl who just turned 2 in May. My life is a little busy! Thanks for the help! > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 7, 2009 Report Share Posted June 7, 2009 Thanks for the info. Be sure to let me know how it turns out! > > > Has anyone had to go through the appeal process with BCBS? My daughter > > Jenna just got her helmet yesterday, and although we haven't gotten a > > denail letter yet, we've been told from the orthotist that it will be > > denied based on their past experience with BCBS. She has been in > > physical therapy for torticollis for about 2 months. She will be 8 > > months on June 8th. The whole appeal process just seems so > > overwhelming to me and I'm not sure I have the time/energy to deal > > with it--Jenna is a twin and I also have another girl who just turned > > 2 in May. My life is a little busy! Thanks for the help! > Quote Link to comment Share on other sites More sharing options...
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