Re: Getting around insurance...

[Guest guest]

We didn't go to Iowa so didn't deal with this. I've read about others who did

though. I think that if you can show your insurance company that the Ponseti

method is superior to ther methods and that there are no practicing dr.s in your

area that follow the Ponseti protocol then you MAY be able to get it covered. We

did have issues with getting the shoes/bar covered and after several phone calls

we were able to do it. I think you can file an appeal and that is how you would

explain the difference in treatments, etc. Maybe if you can point out that

Ponseti treatment is better financially long-term that might help. They would

have to pay for hospital visits, surgery, etc. if you don't go the Ponseti

route. Good luck!

Marcia

Getting around insurance...

I posted this in another thread but realized it is misplaced. I am

reposting it here so as to get more visibility.

" I am working on getting things lined up for our trip. We checked with

our insurance and they will NOT cover any of the costs (~$5,000 out of

pocket). Dr. Ponseti has stated that some people have fought their

insurance on this and had success. Anyone have a anecdotal stories to

share?

-Salem, and Craig <<< finally got the order right

p.s.- We are doing it anyway, but if the insurance will pay, ... "

--- Salem, and Craig + Claire (who isn't in school and is making

the trip with us)::: We are in Laramie, Wyoming for the night...

[Guest guest]

We have what is considered to be very good insurance through Anthem BC/BS,

however they just denied us coverage for both the Markells and the bar.

They called the shoes benesch boots, code L3212. They called the bar Foot

Abduction/rotation, code L3150. Does that sound right? The insurance

company said they do not cover either code. Is the x1 part important? I'm

getting ready to appeal.

and Logan (almost 5mo lcf 1.5mo in the FAB 23/7)

Re: Getting around insurance...

The biggest thing that your insurance company looks @ is the what we call

the (L code). ie: L3150 x1 L3208 x2 L2780 X 1. If the Orthotist is using

differnt codes then the normal, then they might not pay for certain things

that deal with the shoes and bar together.

Tim H. CO PTA

www.clubfootdesigns.com

Marcia wrote:

We didn't go to Iowa so didn't deal with this. I've read about others who

did though. I think that if you can show your insurance company that the

Ponseti method is superior to ther methods and that there are no practicing

dr.s in your area that follow the Ponseti protocol then you MAY be able to

get it covered. We did have issues with getting the shoes/bar covered and

after several phone calls we were able to do it. I think you can file an

appeal and that is how you would explain the difference in treatments, etc.

Maybe if you can point out that Ponseti treatment is better financially

long-term that might help. They would have to pay for hospital visits,

surgery, etc. if you don't go the Ponseti route. Good luck!

Marcia

Getting around insurance...

I posted this in another thread but realized it is misplaced. I am

reposting it here so as to get more visibility.

" I am working on getting things lined up for our trip. We checked with

our insurance and they will NOT cover any of the costs (~$5,000 out of

pocket). Dr. Ponseti has stated that some people have fought their

insurance on this and had success. Anyone have a anecdotal stories to

share?

-Salem, and Craig <<< finally got the order right

p.s.- We are doing it anyway, but if the insurance will pay, ... "

--- Salem, and Craig + Claire (who isn't in school and is making

the trip with us)::: We are in Laramie, Wyoming for the night...