Re: BCBS HMO and coverage in IL

[Guest guest]

I have Empire BC/BS (New York), and I was able to get my son's band covered with

a little work. I suggest that you do all correspondence through the email

feature on their website if they offer one, and print everything out to save. I

had an issue with different reps telling me incorrect/conflicting info, but I

was able to show this with the saved messages I had.

I also found it helpful that I got a document off my insurance company's website

that outlined exactly what the requirements were for them to approve the band as

medically necessary or reconstructive, or turn down the claim as not medically

necessary. Search your insurance company's website or request their guidelines

for coverage of Cranial Orthosis. That way, you'll know what they're looking

for.

The insurance person at CT is very nice and helpful. Use her to help you through

the process. She gave me the codes to use wehn I contacted the insurance company

to find out what they would pay. She will start a predetermination for you to

find out if you can get the band approved. But, if your insurance approves the

band, you also need to find out what they will pay for it. My insurance tried to

tell me I was approved, but they'd only pay $700. I fought them and got 90% paid

instead. I just got the check a few days ago (woo hoo!).

Also, because you have an HMO, you need to find out if you need a referral from

your PCP. You also will need a prescription if you don't have one already.

Again, CT can help you with all of this. Good luck!

>

> My son just went to CT in Oakbrook and was advised a band. We are in the

process of getting the info from his doctor and then getting insurance approval.

I am really nervous about the insurance covering it as I seem to hear more often

they don't. We have BCBS Blue Advantage HMO, through the HPH Hinsdale group.

Has anybody had experience with them in the past. I was told HPH would have to

give the ok since we have the HMO. I read in the file section info about a

previous lawsuit in IL with BCBS. Those files are all older though, any recent

experience?

> Thanks,

> Jen McMillin

>

[Guest guest]

Hi Jen! It's Elliott from the twin club... so funny we're both on here. I have

the exact same insurance and we're in the Hinsdale medical group as well. We

were approved without any issue.. although I think I mentioned to you previously

that we did reposition for two months prior to going to Cranial.

>

> My son just went to CT in Oakbrook and was advised a band. We are in the

process of getting the info from his doctor and then getting insurance approval.

I am really nervous about the insurance covering it as I seem to hear more often

they don't. We have BCBS Blue Advantage HMO, through the HPH Hinsdale group.

Has anybody had experience with them in the past. I was told HPH would have to

give the ok since we have the HMO. I read in the file section info about a

previous lawsuit in IL with BCBS. Those files are all older though, any recent

experience?

> Thanks,

> Jen McMillin

>

[Guest guest]

We have Premara BCBS and they covered our sons helmet at 90%. We took him to

Hanger for his helmet. Good luck on getting the band covered!!

>

> My son just went to CT in Oakbrook and was advised a band. We are in the

process of getting the info from his doctor and then getting insurance approval.

I am really nervous about the insurance covering it as I seem to hear more often

they don't. We have BCBS Blue Advantage HMO, through the HPH Hinsdale group.

Has anybody had experience with them in the past. I was told HPH would have to

give the ok since we have the HMO. I read in the file section info about a

previous lawsuit in IL with BCBS. Those files are all older though, any recent

experience?

> Thanks,

> Jen McMillin

>