Guest guest Posted December 14, 2009 Report Share Posted December 14, 2009 My so was diagnosed brachycephaly and we opted to go w/ the DOC Band our insurance (BCBS of Tx) would not cover it " due to being out of network " so we paid out of pocket. I am aware BCBS has covered the treatment. How can we get reimbursed? Has any one gone through this and been successful in getting reimbursed.... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 16, 2009 Report Share Posted December 16, 2009 I'm in the same boat. My son also has brachycephaly and ,y insurance (United HealthCare) will pay for Hanger helmet (but I wasn't impressed with a passive helmet or the six month timeframe I was given) which is in-network but won't pay for a DOC band since Cranial Technologies is out of network. So we're paying out of pocket and it's going towards out deductible, which is $5000 for a family. But I had a better feeling re: CT and the DOC band. I'm curious if anyone was able to fight this. I'm thinking I have no leg to stand on since they're out of network. It wasn't that UHC denied coverage, it's just a question as to who they will let me use. Good luck. > > My so was diagnosed brachycephaly and we opted to go w/ the DOC Band our insurance (BCBS of Tx) would not cover it " due to being out of network " so we paid out of pocket. I am aware BCBS has covered the treatment. How can we get reimbursed? Has any one gone through this and been successful in getting reimbursed.... > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 16, 2009 Report Share Posted December 16, 2009 Hi - I am also in the same exact boat. My daughter was diagnosed with brachycephaly, we went with the DOC band, we paid upfront, and ... now we've been denied by BCBS CareFirst of Virginia. My research so far has shown that some people have been successful in appealing with BCCS, and so I'm now searching around for sample letters that " won. " If I find a good one, I'll share. Please do the same if you find something! Thanks and good luck! > > > > My so was diagnosed brachycephaly and we opted to go w/ the DOC Band our insurance (BCBS of Tx) would not cover it " due to being out of network " so we paid out of pocket. I am aware BCBS has covered the treatment. How can we get reimbursed? Has any one gone through this and been successful in getting reimbursed.... > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 16, 2009 Report Share Posted December 16, 2009 We did the same thing, but with STARband over Hanger. We did not appeal for the reason that you state. It was our choice to go out of network. Re: Insurance wont cover.... I'm in the same boat. My son also has brachycephaly and ,y insurance (United HealthCare) will pay for Hanger helmet (but I wasn't impressed with a passive helmet or the six month timeframe I was given) which is in-network but won't pay for a DOC band since Cranial Technologies is out of network. So we're paying out of pocket and it's going towards out deductible, which is $5000 for a family. But I had a better feeling re: CT and the DOC band.I'm curious if anyone was able to fight this. I'm thinking I have no leg to stand on since they're out of network. It wasn't that UHC denied coverage, it's just a question as to who they will let me use.Good luck.>> My so was diagnosed brachycephaly and we opted to go w/ the DOC Band our insurance (BCBS of Tx) would not cover it "due to being out of network" so we paid out of pocket. I am aware BCBS has covered the treatment. How can we get reimbursed? Has any one gone through this and been successful in getting reimbursed....> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 17, 2009 Report Share Posted December 17, 2009 sometimes you can get coverage for out of network providers if you can prove no one in network is close enough, but i believe you have to get that approval before you get treatment. > > > > My so was diagnosed brachycephaly and we opted to go w/ the DOC Band our insurance (BCBS of Tx) would not cover it " due to being out of network " so we paid out of pocket. I am aware BCBS has covered the treatment. How can we get reimbursed? Has any one gone through this and been successful in getting reimbursed.... > > > Quote Link to comment Share on other sites More sharing options...
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