7 months working with BCBS TX: approved then denied claim all in 24 hours!

[Guest guest]

I'm beside myself right now. I've jumped through every hoop that BCBS of TX has

asked me to. Finally, yesterday, I received the call they were paying my

claim...well, part of it...$2100 of the $3600 to be exact. They told me that my

son had met his deductible and they were refunding me $191.

Today, I get a call back saying that information was not correct. It went to a

peer review committee who have denied my claim because of an exclusion!

What the heck happened in the last 24 hours that overrides everything I've been

told for the last 7 months?

My son was on the severe side of the scale, his doc band was medicially

necessary based on the Pedi & Cranial Tech's evaluation. I was told there is

coverage for this. I was told my claim was finally paid. Now I'm told it's

denied.

I'm beyond livid right now. I'm still waiting for the EOB to be emailed to me

so that I can see the actual reasons. I work in the insurance industry and my

boss says he's going to help me file this with the insurance comissioner.

I have no idea what to do next...appeal again? I've already appealed once.

This is blowing my mind!!!

Any advice or help would be greatly appreciated!!

[Guest guest]

BCBS did the same thing to me. Before we started the whole banding process,

they told me they would cover. Now after my son got his band, they are saying

they will not cover it. Still trying to deal with them. Good Luck!!

>

> I'm beside myself right now. I've jumped through every hoop that BCBS of TX

has asked me to. Finally, yesterday, I received the call they were paying my

claim...well, part of it...$2100 of the $3600 to be exact. They told me that my

son had met his deductible and they were refunding me $191.

>

> Today, I get a call back saying that information was not correct. It went to

a peer review committee who have denied my claim because of an exclusion!

>

> What the heck happened in the last 24 hours that overrides everything I've

been told for the last 7 months?

>

> My son was on the severe side of the scale, his doc band was medicially

necessary based on the Pedi & Cranial Tech's evaluation. I was told there is

coverage for this. I was told my claim was finally paid. Now I'm told it's

denied.

>

> I'm beyond livid right now. I'm still waiting for the EOB to be emailed to me

so that I can see the actual reasons. I work in the insurance industry and my

boss says he's going to help me file this with the insurance comissioner.

>

> I have no idea what to do next...appeal again? I've already appealed once.

This is blowing my mind!!!

>

> Any advice or help would be greatly appreciated!!

>

[Guest guest]

I just got my letter and the reason they are denying is...

" The cranial molding device is not medically necessary because it is used to

reshape the skull and this is not an illness, injury or disease. The asymetry

has not been shown to cause any significant neurdevelopment or physical disorder

and the cranial band, while effective in producing a more rounded skull shape,

therefore only produces a cosmetic effect. This device is denied as cosmetic. "

PLEASE, ANYONE WHO HAS BEEN THROUGH THIS HELP ME. Your ideas and suggestions

are so very appreciated!!

> >

> > I'm beside myself right now. I've jumped through every hoop that BCBS of TX

has asked me to. Finally, yesterday, I received the call they were paying my

claim...well, part of it...$2100 of the $3600 to be exact. They told me that my

son had met his deductible and they were refunding me $191.

> >

> > Today, I get a call back saying that information was not correct. It went

to a peer review committee who have denied my claim because of an exclusion!

> >

> > What the heck happened in the last 24 hours that overrides everything I've

been told for the last 7 months?

> >

> > My son was on the severe side of the scale, his doc band was medicially

necessary based on the Pedi & Cranial Tech's evaluation. I was told there is

coverage for this. I was told my claim was finally paid. Now I'm told it's

denied.

> >

> > I'm beyond livid right now. I'm still waiting for the EOB to be emailed to

me so that I can see the actual reasons. I work in the insurance industry and

my boss says he's going to help me file this with the insurance comissioner.

> >

> > I have no idea what to do next...appeal again? I've already appealed once.

This is blowing my mind!!!

> >

> > Any advice or help would be greatly appreciated!!

> >

>