Anyone in NJ, help please!

March 19, 2010

I posted about a week and a half or so ago for some advice regarding where to

take our daughter Katelyn for a consultation. Based on that advice we took her

to Cranial Technologies in Paramus, NJ and decided that we are getting her a

DOCband whether insurance pays for it or not. She has her scan this Wednesday

and she'll be getting it on 3/31. Anyway, we have Horizon BCBSNJ insurance and

and it has been an absolute nightmare dealing with them. I have kept a log of

all the conversations (8) that I have had with them over the past 2 weeks - who

I spoke with, what they said, etc. Initially they told us there was nowhere in

netwrok that we could go. We have an HMO plan. They advised us to have our

pediatrician call for out of network authroization. They did, and were told

that Cranial Technologies was in network. We took her there, and when CT called

after our consultation, we were told that they were not in network. We were

told to go to Hanger Orthotics. I researched it and the only locations that do

the cranial orthotics are more than 50 miles from home. So I called Horizon and

was told there were no other places in network. So on Tuesday our pediatrician

called once again to get out of network authorization and today called back to

check on the process. And today we are told that there are 2 other locations in

NJ that are in network:

Next Step Orthopedics in West Orange, NJ and NOPCO a division of Children's

Hospital in Mountainside, NJ.

I am so disgusted with Horizon and annoyed that they could not have provided us

with all of the correct information initially, but am hoping it may work in our

favor. Since they did instruct us to go to Cranial Technologies I am hoping

that may be helpful if we appeal - we went there because they told us it was in

network (and because we heard it was the best.)

As I said, we are definitely going to CT but I would like to gather some

information about these other places to possibly make an appeal to the insurance

company. It is my understanding that certain bands are more effective than

others, and certain brands are better for brachy (which my daughter has.) I

can't find any information about what kinds of bands they use at these locations

or any comments from people who have been there. I'm wondering if anyone has

heard of either. If you made it all the way through this, thanks for reading.

This site is a wonderful resource.

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