Re: Has anyone received approval with the initial insurance submission?

[Guest guest]

I was lucky in this respect. BCBS of VT, The Vermont Health Plan. My

wife tells me that technically, it's an HMO. We made a downpayment

without prior approval, and they sent a letter saying that

technically, because of that, they would have to reconsider the claim

as an appeal. But I never heard anything more about it, and they

paid without further input.

--

Thad Launderville

Montpelier, VT

Clara age 21 months, in STARband ~5 months

On Jan 19, 2010, at 1:30 AM, kandl03@... wrote:

> anyone recevied an approval on the initial insurance submission?

[Guest guest]

Thanks for the imput. Our UHC plan has an orthodic exclusion, so I know we have

a fight ahead of us.

>

> > anyone recevied an approval on the initial insurance submission?

>

[Guest guest]

When our ortho called for preapproval with UHC, we were denied.. We paid for our Becker Band out of pocket and were getting ready to appeal when I got an explanation of benefits letter in the mail that said they covered half of it. Crazy (ridiculous) thing is that the helmet was $1699. The insurance company got a 'patient provider discount' of $679.90. So they really only paid $131.28. But the explanation of benefits says I should have only owed $888.12.I'm still waiting for a check (it's only been two weeks). I was VERY surprised to receive this letter. When I called the insurance company they said they had 'never denied' the claim. I have the inital denial letter that says otherwise.I think a lot of it has to do with medical coding. I have a friend whos husband is a doctor

and she said that it is -very- important that they code things right. A wrong code can lead to denial. I don't know why they overturned their decision without an appeal... I can only imagine that either 1) the neurologist coded correctly or 2) he filed an appeal for us.KatrinaFrom: "kandl03@..." <kandl03@...>Plagiocephaly Sent: Tue, January 19, 2010 10:09:52 PMSubject: Re: Has anyone received approval with the initial insurance submission?

Thanks for the imput. Our UHC plan has an orthodic exclusion, so I know we have a fight ahead of us.

>

> > anyone recevied an approval on the initial insurance submission?

>