Re: new mommy needs advice

[Guest guest]

What the heck? I keep reading about all this BCBS denials. I work there and I don't see many denials. My son got a hanger helmet and blue cross paid it and I just had a 170 deductible. It was covered under DME. Um glad the helmet was covered . My son looks exactly the same to me. I'd be heated if I had paid myselfSent via BlackBerry from T-MobileFrom: "kimbailey_03" Date: Tue, 30 Dec 2008 19:55:35 -0000<Plagiocephaly >Subject: new mommy needs advice My son was diagnosied with Plagiocephaly and torticollis. He will receive his DOC Band on Jan.9th. My husband has BCBS insurance which does not cover the band. Has anyone had an experience with winning an appeal or getting insured for this??? After reading blogs from the Cranial Technolgies website I am relieved in some ways that my husband and I are having this done now and the pediatrician caught it early(my son is 3 months old). However I have concerns about what to expect in the days following the fitting of the band. Will he be able to sleep? Will his skin break out in a heat rash? I defiantely feel that we are making the best decision in going through with the procedure although the medical expense is hard for us being a newly married couple and my husband recently losing his job. I want to make this as painless as possible for all of us and be able to decorate it in a fun way. Does anyone know of any websites that you can get decorating ideas from, or have suggestions? I appreciate any advice you have for me! Thank you! Kim

[Guest guest]

Kim,

We went through one helmet from Eastern Cranial Affiliates and now a DOC band from CT. When we got the helmet from ECA, we had BCBS and we were told that it would probably not be covered. Our experience with ECA has been awful and they never actually filed a claim with BCBS until after we decided to stop treatment with them, ask for a refund and press them again to file a claim. We just got a letter this week saying that BCBS paid for 1875 out of 2900 that the band cost, so you may never know.

We are now with Kaiser Permanente and they paid for our DOC band in full.

I can't help you with any appeals but just because you have BCBS doesn't mean that it won't be covered.

Your son will be fine in his DOC band. My daughter is doing great!

Leila

Maysa, 11m 2w, 8 weeks in DOC band + CST

http://mymaysa.wordpress.com/--- On Tue, 12/30/08, kimbailey_03 <kimbailey_03@...> wrote:

From: kimbailey_03 <kimbailey_03@...>Subject: new mommy needs advicePlagiocephaly Date: Tuesday, December 30, 2008, 2:55 PM

My son was diagnosied with Plagiocephaly and torticollis. He will receive his DOC Band on Jan.9th. My husband has BCBS insurance which does not cover the band. Has anyone had an experience with winning an appeal or getting insured for this??? After reading blogs from the Cranial Technolgies website I am relieved in some ways that my husband and I are having this done now and the pediatrician caught it early(my son is 3 months old). However I have concerns about what to expect in the days following the fitting of the band. Will he be able to sleep? Will his skin break out in a heat rash? I defiantely feel that we are making the best decision in going through with the procedure although the medical expense is hard for us being a newly married couple and my husband recently losing his job. I want to make this as painless as possible for all of us and be able to decorate it in a fun way. Does anyone

know of any websites that you can get decorating ideas from, or have suggestions? I appreciate any advice you have for me!Thank you!Kim

[Guest guest]

Thanks for your email and suggestion. I'm glad to hear that your daughter is doing welll in her band!

From: kimbailey_03 <kimbailey_03>Subject: new mommy needs advicePlagiocephalyDate: Tuesday, December 30, 2008, 2:55 PM

My son was diagnosied with Plagiocephaly and torticollis. He will receive his DOC Band on Jan.9th. My husband has BCBS insurance which does not cover the band. Has anyone had an experience with winning an appeal or getting insured for this??? After reading blogs from the Cranial Technolgies website I am relieved in some ways that my husband and I are having this done now and the pediatrician caught it early(my son is 3 months old). However I have concerns about what to expect in the days following the fitting of the band. Will he be able to sleep? Will his skin break out in a heat rash? I defiantely feel that we are making the best decision in going through with the procedure although the medical expense is hard for us being a newly married couple and my husband recently losing his job. I want to make this as painless as possible for all of us and be able to decorate it in a fun way. Does anyone

know of any websites that you can get decorating ideas from, or have suggestions? I appreciate any advice you have for me!Thank you!Kim

[Guest guest]

I'm glad to hear you didn't have tp pay.

From: mommy2jaylina@... <mommy2jaylina@...>Subject: Re: new mommy needs advicePlagiocephaly Date: Tuesday, December 30, 2008, 6:36 PM

What the heck? I keep reading about all this BCBS denials. I work there and I don't see many denials. My son got a hanger helmet and blue cross paid it and I just had a 170 deductible. It was covered under DME. Um glad the helmet was covered . My son looks exactly the same to me. I'd be heated if I had paid myself

Sent via BlackBerry from T-Mobile

From: "kimbailey_03" Date: Tue, 30 Dec 2008 19:55:35 -0000<Plagiocephaly>Subject: new mommy needs advice

My son was diagnosied with Plagiocephaly and torticollis. He will receive his DOC Band on Jan.9th. My husband has BCBS insurance which does not cover the band. Has anyone had an experience with winning an appeal or getting insured for this??? After reading blogs from the Cranial Technolgies website I am relieved in some ways that my husband and I are having this done now and the pediatrician caught it early(my son is 3 months old). However I have concerns about what to expect in the days following the fitting of the band. Will he be able to sleep? Will his skin break out in a heat rash? I defiantely feel that we are making the best decision in going through with the procedure although the medical expense is hard for us being a newly married couple and my husband recently losing his job. I want to make this as painless as possible for all of us and be able to decorate it in a fun way. Does anyone

know of any websites that you can get decorating ideas from, or have suggestions? I appreciate any advice you have for me!Thank you!Kim

[Guest guest]

We have a middle of the road BCBS PPO plan and they covered our daughter's first helmet 100%, and at least part of her second. She hasn't gotten it yet so we're not sure on the details, just that enough was approved that they made it without making payment arrangements with us (here's hoping it's 100% again). Her first fitting in it is next week. Depending on the insurance it can depend on how you arrived to get the helmet. Some want to see that you tried PT/repositioning first so they won't approve it before then.

We're not an average case as our daughter was the bottom twin and had plagio and sever tort when she was born. Our escalation went like this: PT starting at two weeks old, referral to a surgeon ~3 months, re check with the surgeon at 4 months, surgical (for the tort) and helmet referral, in her helmet by 4 1/2 months. After her surgery (she had a tumor removed from her skull and her neck injected with botox to help her tort) she was out of the helmet for two weeks. It was getting to the point there wasn't much room for adjustment anyway, but she grew out of it. Our ortho and surgeon did the appeal of medical necessity to the insurance for the second helmet for us. Perhaps you could get the information from your ortho and doctors and put together a medical necessity appeal yourself? There's a section on this site dedicated to such things that could help.

As for adjusting to it, most kids wear their helmets/bands from day one with no issues. There's a break-in schedule you'll follow that makes the adjustment period pretty smooth. Here's hoping you are the rule and not the exception in that regard.

As for decorating it, there is a section on this site about that too~

Elaine (twin a) plagio & tort, helmet

On Tue, Dec 30, 2008 at 2:55 PM, kimbailey_03 <kimbailey_03@...> wrote:

My son was diagnosied with Plagiocephaly and torticollis. He will receive his DOC Band on Jan.9th. My husband has BCBS insurance which does not cover the band. Has anyone had an experience with winning an

appeal or getting insured for this??? After reading blogs from the Cranial Technolgies website I am relieved in some ways that my husband and I are having this done now and the pediatrician caught it early(my

son is 3 months old). However I have concerns about what to expect in the days following the fitting of the band. Will he be able to sleep? Will his skin break out in a heat rash? I defiantely feel that we are

making the best decision in going through with the procedure although the medical expense is hard for us being a newly married couple and my husband recently losing his job. I want to make this as painless as

possible for all of us and be able to decorate it in a fun way. Does anyone know of any websites that you can get decorating ideas from, or have suggestions? I appreciate any advice you have for me!Thank you!

Kim

[Guest guest]

thank you for your reply. What I have been told is that BCBS does not have a contract with Cranial Technologies therefore they settled on an agreement of $2000 fee for the helmet. I have spoken with the cranial rep and BCBS and they both felt there was no way around it. I will look on the website to see if their are any suggestions on how to formerlly do an appeal, but it is looking like we are just going to absorb the cost.

My son was diagnosied with Plagiocephaly and torticollis. He will receive his DOC Band on Jan.9th. My husband has BCBS insurance which does not cover the band. Has anyone had an experience with winning an appeal or getting insured for this??? After reading blogs from the Cranial Technolgies website I am relieved in some ways that my husband and I are having this done now and the pediatrician caught it early(my son is 3 months old). However I have concerns about what to expect in the days following the fitting of the band. Will he be able to sleep? Will his skin break out in a heat rash? I defiantely feel that we are making the best decision in going through with the procedure although the medical expense is hard for us being a newly married couple and my husband recently losing his job. I want to make this as painless as possible for all of us and be able to decorate it in a fun way. Does anyone

know of any websites that you can get decorating ideas from, or have suggestions? I appreciate any advice you have for me!Thank you!Kim

[Guest guest]

I'm sorry to hear that. I'd talk to others here that had to appeal to BCBS. It can't hurt right? You may even want to get the HR department involved if you're insured through work. There are success stories on here with people getting reimbursement after appealing for months. Hopefully you'll be one of them In our case we're not going through CT, we're going through an ortho that works out of the Children's Hospital of Detroit along side our (well Elly's) surgeon which could be a difference in our case making approval easier.

However it turns out, you are making the right choice. I'd go in debt if I had to to get a helmet for our daughter. I hated it at first (does anyone like it?), but after seeing her improve I can hardly believe I was ever upset about it. It's worth everything and I'd do it again in a heartbeat.

Elaine (twin A) severe plagio & CMT, helmet

On Mon, Jan 5, 2009 at 1:16 PM, Kim <kimbailey_03@...> wrote:

thank you for your reply. What I have been told is that BCBS does not have a contract with Cranial Technologies therefore they settled on an agreement of $2000 fee for the helmet. I have spoken with the cranial rep and BCBS and they both felt there was no way around it. I will look on the website to see if their are any suggestions on how to formerlly do an appeal, but it is looking like we are just going to absorb the cost.

My son was diagnosied with Plagiocephaly and torticollis. He will receive his DOC Band on Jan.9th. My husband has BCBS insurance which does not cover the band. Has anyone had an experience with winning an

appeal or getting insured for this??? After reading blogs from the Cranial Technolgies website I am relieved in some ways that my husband and I are having this done now and the pediatrician caught it early(my

son is 3 months old). However I have concerns about what to expect in the days following the fitting of the band. Will he be able to sleep? Will his skin break out in a heat rash? I defiantely feel that we are

making the best decision in going through with the procedure although the medical expense is hard for us being a newly married couple and my husband recently losing his job. I want to make this as painless as

possible for all of us and be able to decorate it in a fun way. Does anyone know of any websites that you can get decorating ideas from, or have suggestions? I appreciate any advice you have for me!Thank you!

Kim

[Guest guest]

I work for BCBS. CT is great but it sucks they won't become par! Good luck hunSent via BlackBerry from T-MobileFrom: Kim Date: Mon, 5 Jan 2009 10:16:44 -0800 (PST)<Plagiocephaly >Subject: Re: new mommy needs advice thank you for your reply. What I have been told is that BCBS does not have a contract with Cranial Technologies therefore they settled on an agreement of $2000 fee for the helmet. I have spoken with the cranial rep and BCBS and they both felt there was no way around it. I will look on the website to see if their are any suggestions on how to formerlly do an appeal, but it is looking like we are just going to absorb the cost.My son was diagnosied with Plagiocephaly and torticollis. He will receive his DOC Band on Jan.9th. My husband has BCBS insurance which does not cover the band. Has anyone had an experience with winning an appeal or getting insured for this??? After reading blogs from the Cranial Technolgies website I am relieved in some ways that my husband and I are having this done now and the pediatrician caught it early(my son is 3 months old). However I have concerns about what to expect in the days following the fitting of the band. Will he be able to sleep? Will his skin break out in a heat rash? I defiantely feel that we are making the best decision in going through with the procedure although the medical expense is hard for us being a newly married couple and my husband recently losing his job. I want to make this as painless as possible for all of us and be able to decorate it in a fun way. Does anyone know of any websites that you can get decorating ideas from, or have suggestions? I appreciate any advice you have for me!Thank you!Kim

[Guest guest]

Though I don't like it...I know it is best. I'm glad you had results.

My son was diagnosied with Plagiocephaly and torticollis. He will receive his DOC Band on Jan.9th. My husband has BCBS insurance which does not cover the band. Has anyone had an experience with winning an appeal or getting insured for this??? After reading blogs from the Cranial Technolgies website I am relieved in some ways that my husband and I are having this done now and the pediatrician caught it early(my son is 3 months old). However I have concerns about what to expect in the days following the fitting of the band. Will he be able to sleep? Will his skin break out in a heat rash? I defiantely feel that we are making the best decision in going through with the procedure although the medical expense is hard for us being a newly married couple and my husband recently losing his job. I want to make this as painless as possible for all of us and be able to decorate it in a fun way. Does anyone

know of any websites that you can get decorating ideas from, or have suggestions? I appreciate any advice you have for me!Thank you!Kim

[Guest guest]

Hi,

I'm curious...Cranial Technologies is only charging you 2000? Or did they come

to a deal

with BCBS. I was told BCBS isn't in contract so I have to pay 3,600. Does you

BCBS have out

of network benefits?

>

>

>

>

>

>

> My son was diagnosied with Plagiocephaly and torticollis. He will

> receive his DOC Band on Jan.9th. My husband has BCBS insurance which

> does not cover the band. Has anyone had an experience with winning an

> appeal or getting insured for this??? After reading blogs from the

> Cranial Technolgies website I am relieved in some ways that my husband

> and I are having this done now and the pediatrician caught it early(my

> son is 3 months old). However I have concerns about what to expect in

> the days following the fitting of the band. Will he be able to sleep?

> Will his skin break out in a heat rash? I defiantely feel that we are

> making the best decision in going through with the procedure although

> the medical expense is hard for us being a newly married couple and my

> husband recently losing his job. I want to make this as painless as

> possible for all of us and be able to decorate it in a fun way. Does

> anyone know of any websites that you can get decorating ideas from, or

> have suggestions? I appreciate any advice you have for me!

>

> Thank you!

>

> Kim

>

[Guest guest]

I was told that they worked out a deal with BCBS to get it that rate. Luckily we were able to use my husband's insurance before it canceled a day later. My insurance it would have been $3600 as well(I have WellPath). I would contact CT about your rate...Good Luck!!!

From: <b00k_girl@...>Subject: Re: new mommy needs advicePlagiocephaly Date: Tuesday, January 6, 2009, 11:31 PM

Hi,I'm curious...Cranial Technologies is only charging you 2000? Or did they come to a deal with BCBS. I was told BCBS isn't in contract so I have to pay 3,600. Does you BCBS have out of network benefits? > > > > > > > My son was diagnosied with Plagiocephaly and torticollis. He will > receive his DOC Band on Jan.9th. My husband has BCBS insurance which > does not cover the band. Has anyone had an experience with winning an > appeal or getting insured for this??? After reading blogs from the > Cranial Technolgies website I am

relieved in some ways that my husband > and I are having this done now and the pediatrician caught it early(my > son is 3 months old). However I have concerns about what to expect in > the days following the fitting of the band. Will he be able to sleep? > Will his skin break out in a heat rash? I defiantely feel that we are > making the best decision in going through with the procedure although > the medical expense is hard for us being a newly married couple and my > husband recently losing his job. I want to make this as painless as > possible for all of us and be able to decorate it in a fun way. Does > anyone know of any websites that you can get decorating ideas from, or > have suggestions? I appreciate any advice you have for me!> > Thank you!> > Kim>

[Guest guest]

So just for further clarification, are you responsible for the

remaining $1600?

Jake-2 (DOCBand Grad 9/08)

Jordan-4.5

> >

> >

> >

> >

> >

> >

> > My son was diagnosied with Plagiocephaly and torticollis. He

will

> > receive his DOC Band on Jan.9th. My husband has BCBS insurance

which

> > does not cover the band. Has anyone had an experience with

winning an

> > appeal or getting insured for this??? After reading blogs from

the

> > Cranial Technolgies website I am relieved in some ways that my

husband

> > and I are having this done now and the pediatrician caught it

early(my

> > son is 3 months old). However I have concerns about what to

expect in

> > the days following the fitting of the band. Will he be able to

sleep?

> > Will his skin break out in a heat rash? I defiantely feel that

we are

> > making the best decision in going through with the procedure

although

> > the medical expense is hard for us being a newly married couple

and my

> > husband recently losing his job. I want to make this as painless

as

> > possible for all of us and be able to decorate it in a fun way.

Does

> > anyone know of any websites that you can get decorating ideas

from, or

> > have suggestions? I appreciate any advice you have for me!

> >

> > Thank you!

> >

> > Kim

> >

>

[Guest guest]

I was told to pay $2000 and BCBS may refund me $400...I'm not sure when however

From: <nwilkens2275@...>Subject: Re: new mommy needs advicePlagiocephaly Date: Wednesday, January 7, 2009, 1:27 PM

So just for further clarification, are you responsible for the remaining $1600?Jake-2 (DOCBand Grad 9/08)Jordan-4.5> > > > > > > > > > >

> > > My son was diagnosied with Plagiocephaly and torticollis. He will > > receive his DOC Band on Jan.9th. My husband has BCBS insurance which > > does not cover the band. Has anyone had an experience with winning an > > appeal or getting insured for this??? After reading blogs from the > > Cranial Technolgies website I am relieved in some ways that my husband > > and I are having this done now and the pediatrician caught it early(my > > son is 3 months old). However I have concerns about what to expect in > > the days following the fitting of the band. Will he be able to sleep? > > Will his skin break out in a heat rash? I defiantely feel that we are > > making the best decision in going through with the procedure although > > the medical expense is hard for us being a newly married couple and my

> > husband recently losing his job. I want to make this as painless as > > possible for all of us and be able to decorate it in a fun way. Does > > anyone know of any websites that you can get decorating ideas from, or > > have suggestions? I appreciate any advice you have for me!> > > > Thank you!> > > > Kim> >>