Re: Anyone had approval through FL Medicaid?

May 28, 2010

I don't know how Hanger operates, but Cranial Tech put together a package with

pictures and medical captions that they sent to the insurance company for me. My

advice is to find out who does the insurance at Hanger. Get their name and

number and see if they can help clarify the process for you. Ask the insurance

person at Hanger for the diagnosis and service codes to give to the insurance

company. That's what they use to determine how much they'll pay. Also, if

possible, ask all your questions to Universal through email. That way, when they

tell you conflicting information, you have it all written down to prove what

they told you. Save everything!

There are really two questions you need answered. 1. Will they cover the band,

and what are their requirements as far as measurements, etc. to make it

medically necessary/reconstructive? 2. If it is covered, how much will they pay

for it? Get the answers to these questions in writing. I also had my insurance

company do a " predetermination " where they look at all the measurements/info

beforehand and decide if they will cover the band before you actually order it.

That way, you don't get any surprises. Keep in mind that they can approve your

predetermination, but not pay for the whole price of the band. My insurance

approved mine, but they tried to tell me they would only pay for $700 because it

was the " reasonable and customary " amount. I was able to fight them and win, but

it took several emails. Good luck!

>

> I was just wondering if anyone has been approved for a Hanger band through

Florida Medicaid. We live in Broward, which has Medicaid Reform so I went with

Universal's UFirst plan. Universal is giving me conflicting information but I do

know i was told they follow medicaid's rules. Antwan has his appt at Hanger on

June 1. I was also wondering what needs to be submitted to insurance besides a

letter of medical necessity and a script? I know the insurance company is going

to need more than just that so i would like to go to the appointment tuesday

with everything i need.

> I really appreciate the help btw. this all has my head spinning!

>

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