Insurance question (we have BC/BS)

[Guest guest]

Hi there,

I am about to file my insurance claim and noticed the diagnosis in the letter

from our doc is only for plagiocephaly. Should I have our doc include a

diagnosis and code for torticollis too? Do you think this will help our case?

Also, if anyone has any suggestions for getting BC/BS to cover costs, please

email me!

Thanks so much!

Jackie

[Guest guest]

I don't think it matters because they don't look at the absence/presence of tort

when deciding whether to cover the claim or not. They just want to know about

the child's age and asymmetry measurements. Which BCBS do you have? I dealt with

Empire.

>

> Hi there,

>

> I am about to file my insurance claim and noticed the diagnosis in the letter

from our doc is only for plagiocephaly. Should I have our doc include a

diagnosis and code for torticollis too? Do you think this will help our case?

>

> Also, if anyone has any suggestions for getting BC/BS to cover costs, please

email me!

>

> Thanks so much!

> Jackie

>

[Guest guest]

Hi Jackie, From what I understand BCBS pays very well for bands. I was concerned that my health coverage was not going to pay (Medcost) and my orthotist was telling me that he had never had a denial form BCBS. Medcost ended up paying 80% so I was thrilled with that. I think you will be fine with just the plagio diagnosis and if they give you any trouble then go back and add the tort diag.

From: jackfish215 <jackfish215@...>Plagiocephaly Sent: Thu, July 22, 2010 9:26:17 AMSubject: Insurance question (we have BC/BS)

Hi there,I am about to file my insurance claim and noticed the diagnosis in the letter from our doc is only for plagiocephaly. Should I have our doc include a diagnosis and code for torticollis too? Do you think this will help our case?Also, if anyone has any suggestions for getting BC/BS to cover costs, please email me!Thanks so much!Jackie

[Guest guest]

Jackie,I think that there is variation in not only how much BCBS pays for bands, but also whether they cover them at all. Insurance coverage will not only vary from state to state, but also plan coverages can vary as well. Our insurance company CareFirst BCBS of DC/MD paid for my daughter's band(two-thirds of the cost w/ a preferred provider-would have been only one-third with an out-of-network provider.) The nurse practioner in my daughter's neurosurgeon's office was surprised that BCBS paid for my daughter's band w/o an appeal because she was having a difficult time getting them to pay for a helmet for surgery purposes(could have been Anthem BCBS out of VA?) She said that whether a band is covered can be affected just by the individual adjuster handling the claim. This lack of

"uniformity" seems like even more of a reason for an appeal if a claim is turned down.By the way, CareFirst BCBS won't approve coverage before treatment and will only decide whether to cover it after treatment. I think a big factor in getting insurance to cover our band is that we had a letter from a neurosurgeon, who also told me that my daughter's band would not be covered w/o it.Good luck!-Amy From: Rutledge <crutledge92@...>Plagiocephaly Sent:

Sun, July 25, 2010 9:03:38 PMSubject: Re: Insurance question (we have BC/BS)

Hi Jackie, From what I understand BCBS pays very well for bands. I was concerned that my health coverage was not going to pay (Medcost) and my orthotist was telling me that he had never had a denial form BCBS. Medcost ended up paying 80% so I was thrilled with that. I think you will be fine with just the plagio diagnosis and if they give you any trouble then go back and add the tort diag.

From: jackfish215 <jackfish215>PlagiocephalySent: Thu, July 22, 2010 9:26:17 AMSubject: Insurance question (we have BC/BS)

Hi there,I am about to file my insurance claim and noticed the diagnosis in the letter from our doc is only for plagiocephaly. Should I have our doc include a diagnosis and code for torticollis too? Do you think this will help our case?Also, if anyone has any suggestions for getting BC/BS to cover costs, please email me!Thanks so much!Jackie

[Guest guest]

BCBS is covering our band...we just had to send in a request for coverage...our

insurance stinks so its still gonna cost us alot but every little bit helps.

>

> Hi there,

>

> I am about to file my insurance claim and noticed the diagnosis in the letter

from our doc is only for plagiocephaly. Should I have our doc include a

diagnosis and code for torticollis too? Do you think this will help our case?

>

> Also, if anyone has any suggestions for getting BC/BS to cover costs, please

email me!

>

> Thanks so much!

> Jackie

>

[Guest guest]

hmo totally different from other bcbs plans. Is it an hmo?

Insurance question (we have BC/BS)

Hi there,

I am about to file my insurance claim and noticed the diagnosis in the letter from our doc is only for plagiocephaly. Should I have our doc include a diagnosis and code for torticollis too? Do you think this will help our case?

Also, if anyone has any suggestions for getting BC/BS to cover costs, please email me!

Thanks so much!

Jackie

[Guest guest]

I am glad yo hear they are covering the band. We had a BCBS HMO when my daughter was banded. They had an actual exclusion for head remolding devices. My daughter is 8 1/2 and they still have the exclusion. It is so frustrating to hear about insurance companies still denying coverage after all of these years. Congrats on them paying for some of the band.

Angie

Re: Insurance question (we have BC/BS)

BCBS is covering our band...we just had to send in a request for coverage...our insurance stinks so its still gonna cost us alot but every little bit helps.>> Hi there,> > I am about to file my insurance claim and noticed the diagnosis in the letter from our doc is only for plagiocephaly. Should I have our doc include a diagnosis and code for torticollis too? Do you think this will help our case?> > Also, if anyone has any suggestions for getting BC/BS to cover costs, please email me!> > Thanks so much!> Jackie>

[Guest guest]

I've actually heard a lot of different stories about BCBS as well. I am in MD and mine is Carefirst BCBS of MD PPO. My partner has the federal government's version of Carefirst and it is an HMO. She also had another option of BCBS that was totally different. At the time of 's band, was covered under MDIPA through my partner.

Anyway, my partner's policy excludes paying for bands all together. Mine doesn't mention it, but I was told by my cranial doctor that they almost always deny it. My coworker was turned down and appealed the decision. She was verbally told over the phone that she had won the appeal, but when she called back to find out about the payment, they said that they had no record of any outcome to her appeal. That was a couple of months ago. If we had under my partner's second BCBS option, the band would have been covered at 100 percent.

So, the bottom line is that I think that there are a ton of BCBS options and it sounds like some pay and some don't.

From: "jlady121@..." <jlady121@...>Plagiocephaly Sent: Tue, July 27, 2010 9:49:21 AMSubject: Re: Insurance question (we have BC/BS)

hmo totally different from other bcbs plans. Is it an hmo?

Insurance question (we have BC/BS)

Hi there,I am about to file my insurance claim and noticed the diagnosis in the letter from our doc is only for plagiocephaly. Should I have our doc include a diagnosis and code for torticollis too? Do you think this will help our case?Also, if anyone has any suggestions for getting BC/BS to cover costs, please email me!Thanks so much!Jackie

[Guest guest]

No PPO.From: "jlady121@..." <jlady121@...>Plagiocephaly Sent: Tue, July 27, 2010 9:49:21 AMSubject: Re: Insurance question (we have BC/BS)

hmo totally different from other bcbs plans. Is it an hmo?

Insurance question (we have BC/BS)

Hi there,

I am about to file my insurance claim and noticed the diagnosis in the letter from our doc is only for plagiocephaly. Should I have our doc include a diagnosis and code for torticollis too? Do you think this will help our case?

Also, if anyone has any suggestions for getting BC/BS to cover costs, please email me!

Thanks so much!

Jackie

[Guest guest]

I have Carefirst BCBS of MD/DC (PPO) (Fed.Employee Program) and it specifically addresses "dynamic" cranial orthosis/bands as being covered provided certain criteria is met under the durable medical equipment section in the 2010 bulletin. Don't know if this is new to 2010, since I didn't have a reason to research it before this year.I agree--a lot of variations with BCBS.From: <watsonmel3@...>Plagiocephaly Sent: Tue, July 27, 2010 2:20:59 PMSubject: Re: Insurance question (we have BC/BS)

I've actually heard a lot of different stories about BCBS as well. I am in MD and mine is Carefirst BCBS of MD PPO. My partner has the federal government's version of Carefirst and it is an HMO. She also had another option of BCBS that was totally different. At the time of 's band, was covered under MDIPA through my partner.

Anyway, my partner's policy excludes paying for bands all together. Mine doesn't mention it, but I was told by my cranial doctor that they almost always deny it. My coworker was turned down and appealed the decision. She was verbally told over the phone that she had won the appeal, but when she called back to find out about the payment, they said that they had no record of any outcome to her appeal. That was a couple of months ago. If we had under my partner's second BCBS option, the band would have been covered at 100 percent.

So, the bottom line is that I think that there are a ton of BCBS options and it sounds like some pay and some don't.

From: "jlady121aol (DOT) com" <jlady121aol (DOT) com>PlagiocephalySent: Tue, July 27, 2010 9:49:21 AMSubject: Re: Insurance question (we have BC/BS)

hmo totally different from other bcbs plans. Is it an hmo?

Insurance question (we have BC/BS)

Hi there,I am about to file my insurance claim and noticed the diagnosis in the letter from our doc is only for plagiocephaly. Should I have our doc include a diagnosis and code for torticollis too? Do you think this will help our case?Also, if anyone has any suggestions for getting BC/BS to cover costs, please email me!Thanks so much!Jackie

[Guest guest]

My partner's policy is through the federal government (DOD employee), but it's an HMO. We also looked at the 2010 version since that is when she switched and hers specifically excludes cranial orthosis. She chose that plan because she needed new hearing aids and they paid well for that. The kids will be double covered under my plan starting in September (school districts have a different plan year). Then, in January, they will just be on my plan since mine is also a PPO and so we have more out of network options.

Of course, we were also told initially by MDIPA that the plan had cranial orthosis as an exclusion, but then two weeks later, we got a letter than said that the exception to the rule was if we went through Hanger. I remember reading a later post saying that Star cranial is now in their network so they must have changed this. That was after they had told Star Cranial over the phone that they would cover the band under durable medical equipment at either 100 or 50 percent if we waited for insurance approval. We were so frustrated and called the insurance company several times to try and get the story straight. Even after we got the letter saying that Hanger would be covered, I called them. Over the phone, they still said that it was an exclusion until I referenced the letter. So, I called Hanger, but they said it would probably be a full month before she could be banded.

I agree that the whole insurance thing is a mess.

From: Amy McGinnis <mcg_woo@...>Plagiocephaly Sent: Tue, July 27, 2010 5:56:32 PMSubject: Re: Insurance question (we have BC/BS)

I have Carefirst BCBS of MD/DC (PPO) (Fed.Employee Program) and it specifically addresses "dynamic" cranial orthosis/bands as being covered provided certain criteria is met under the durable medical equipment section in the 2010 bulletin. Don't know if this is new to 2010, since I didn't have a reason to research it before this year.I agree--a lot of variations with BCBS.

From: <watsonmel3 (DOT) com>PlagiocephalySent: Tue, July 27, 2010 2:20:59 PMSubject: Re: Insurance question (we have BC/BS)

I've actually heard a lot of different stories about BCBS as well. I am in MD and mine is Carefirst BCBS of MD PPO. My partner has the federal government's version of Carefirst and it is an HMO. She also had another option of BCBS that was totally different. At the time of 's band, was covered under MDIPA through my partner.

Anyway, my partner's policy excludes paying for bands all together. Mine doesn't mention it, but I was told by my cranial doctor that they almost always deny it. My coworker was turned down and appealed the decision. She was verbally told over the phone that she had won the appeal, but when she called back to find out about the payment, they said that they had no record of any outcome to her appeal. That was a couple of months ago. If we had under my partner's second BCBS option, the band would have been covered at 100 percent.

So, the bottom line is that I think that there are a ton of BCBS options and it sounds like some pay and some don't.

From: "jlady121aol (DOT) com" <jlady121aol (DOT) com>PlagiocephalySent: Tue, July 27, 2010 9:49:21 AMSubject: Re: Insurance question (we have BC/BS)

hmo totally different from other bcbs plans. Is it an hmo?

Insurance question (we have BC/BS)

Hi there,I am about to file my insurance claim and noticed the diagnosis in the letter from our doc is only for plagiocephaly. Should I have our doc include a diagnosis and code for torticollis too? Do you think this will help our case?Also, if anyone has any suggestions for getting BC/BS to cover costs, please email me!Thanks so much!Jackie

[Guest guest]

Coverage through BC/BS does vary by plan, state, etc. We have Anthem BC/BS of

VA through my husband's employer and were denied coverage for our son's DOCband

because it's 'cosmetic' (sorry don't have the paper in front of me for exact

wording). Our original claim included a letter of medical necessity from our

ped. neurosurgeon. I am in the process of appealing and am including any and

all notes from his ped. and the ped. neuro. that address his plagio and tort,

including pics from when he was a newborn showing the tort. I figure this is

not a case of less is more. I am also providing them with the letter of med.

necessity from both doctors.

We also didn't get an insurance discount through CT because our insurance

considers CT out-of-network.

Best of luck!

>

> Jackie,

>

> I think that there is variation in not only how much BCBS pays for bands, but

> also whether they cover them at all. Insurance coverage will not only vary

from

> state to state, but also plan coverages can vary as well. Our insurance

company

> CareFirst BCBS of DC/MD paid for my daughter's band(two-thirds of the cost w/

a

> preferred provider-would have been only one-third with an out-of-network

> provider.) The nurse practioner in my daughter's neurosurgeon's office was

> surprised that BCBS paid for my daughter's band w/o an appeal because she was

> having a difficult time getting them to pay for a helmet for surgery

> purposes(could have been Anthem BCBS out of VA?) She said that whether a band

> is covered can be affected just by the individual adjuster handling the claim.

> This lack of " uniformity " seems like even more of a reason for an appeal if a

> claim is turned down.

>

> By the way, CareFirst BCBS won't approve coverage before treatment and will

only

> decide whether to cover it after treatment. I think a big factor in getting

> insurance to cover our band is that we had a letter from a neurosurgeon, who

> also told me that my daughter's band would not be covered w/o it.

>

> Good luck!

> -Amy

>

>

>

>

>

>

> ________________________________

> From: Rutledge <crutledge92@...>

> Plagiocephaly

> Sent: Sun, July 25, 2010 9:03:38 PM

> Subject: Re: Insurance question (we have BC/BS)

>

>

> Hi Jackie, From what I understand BCBS pays very well for bands. I was

> concerned that my health coverage was not going to pay (Medcost) and my

> orthotist was telling me that he had never had a denial form BCBS. Medcost

> ended up paying 80% so I was thrilled with that. I think you will be fine

with

> just the plagio diagnosis and if they give you any trouble then go back and

add

> the tort diag.

>

>

>

>

> ________________________________

> From: jackfish215 <jackfish215>

> Plagiocephaly

> Sent: Thu, July 22, 2010 9:26:17 AM

> Subject: Insurance question (we have BC/BS)

>

>

> Hi there,

>

> I am about to file my insurance claim and noticed the diagnosis in the letter

> from our doc is only for plagiocephaly. Should I have our doc include a

> diagnosis and code for torticollis too? Do you think this will help our case?

>

> Also, if anyone has any suggestions for getting BC/BS to cover costs, please

> email me!

>

> Thanks so much!

> Jackie

>