Re: Insurance issues - a vent

[Guest guest]

I have never been billed for something that happened at a Shriner's facility. But, they have asked me to have testing done outside of their facility and ordered by our pediatrician. I wasn't saying Shriner's billed us. JaneFrom: NIck Guthe <nickguthe@...>infantile scoliosis treatment Sent: Tue, October 26, 2010 7:31:01 PMSubject: Re: Insurance issues - a vent

Just to chime in, we went for an MRI at Primary Children's in SLC and they did bill our insurance. We've never been billed for anything at Shriners, nor has our insurance. Not sure if policy has changed? We chose to get it done there (in SLC versus here in L.A.) to avoid longer out of cast time- it was only 2 days this way. Shriners may pick it up if you are not covered, ours was. Heidi, Bexon's Mommy, (3 years old, in 6th cast from Salt Lake City Shriners, currently down from 62 degrees to 20 in cast)From: Borlik

<christina_borlik@...>infantile scoliosis <infantile scoliosis treatment >Sent: Tue, October 26, 2010 11:36:48 AMSubject: RE: Insurance issues - a vent

Hi Jane,Thanks for sharing. I did want to add though that each Shriner's hospital must do things a little differently then. When Noah was seen at Shriners Chicago they ordered an MRI for him at a local children's hospital since they didn't have MRI capabilities. They took my insurance info and said they would submit to my inusrance and then whatever my insurance did not pay - they would cover. My insurance paid 80% of the MRI and Shriners paid the remaining 20%. When Noah was treated at Salt Lake City Shriners and needed another MRI they again ordered it at a local children's hospital. SLC did not take my insurance info and nothing was ever submitted. I was told that the Shriner's took care of it all. I did ask my care coordinator why they wouldn't submit to our insurance so that they would at least pick up a portion of the bill and she said they simply choose not to

employ a billing dept. to keep their expenses down.So, in both cases I never paid a penny. I am very grateful for this because we have been paying for all travel (flights, hotels, food etc.) on our own for the last 3 1/2 years and that's an expensive enough medical expense.PS - Very disturbed by your cath experience. Shame on them!~Noah 5 years old9 months of casting in SLC; 2 1/2 years of bracing; Currently treatment-free at 8*And Mariella 1 yr old - resolved Infantile Scoliosisinfantile scoliosis treatment From: janemhar@...Date: Mon, 25 Oct 2010 11:43:42 -0700Subject: Re: Insurance issues - a vent

I don't know about the hospital's you guys go to, but here in Portland at Shriner's, there is still certain things they don't cover and do ask that you have back-up insurance for those things. For example, CT's, MRI's, and whatnot. In addition, IF your child was to need surgery, and there were things that the "free hospital" doesn't cover, again, your insurance would be expected to cover it. When Grace had her spine surgery, our Shriner's doesn't have a Pediatric ICU, so she was transferred for 24 hours to the local children's hospital nearby for PICU services. This was not covered by Shriner's, but instead was covered by my medical insurance. Shriner's did however pay the co-pay I would have been required to pay.

I'm not standing up for the insurance companies, I think a lot of things are crappy when it comes to coverage or the lack there of for medically necessary treatment, but I'm sure they feel they need to know up front what someone has and look at the potential long term needs. Also kids are now covered by a parent's insurance until what, the age of 25? And most of the "free" hospitals, (again, at least Shriner's) ends services at 18, so your insurance, if you have it that long, will end up being the responsible party.

That said, I just got denied life insurance due to my weight. My weight is my ONLY issue. I don't have high cholesterol, high bp, diabetes, etc. NOTHING, and I got denied. In addition, a lot of companies won't cover catheters for kids who need intermittent cathing (like what Grace would need if we weren't going to get the Mitrofanoff done in the next year). Some only cover 2 (!) per month, for kids that need cathing 4-6 times a DAY. It is a proven fact that re-using caths is a big cause for repeat infections (and in our case the reason we would be cathing is to avoid infections in the first place), which diagnostics and treatment of an infection is extraordinarily higher than just covering the cost of single-use caths. Go figure. And that is an issue outside of what Shriner's deals with, that is related to her other anomalies, that my insurance will

need to do something about.

I guess what I'm trying to say, is our kids are one whole being, and I know at least for us, we can't get our services in "one stop shopping" at one hospital or clinic. So a piece of me understands why the insurance needs to see the big picture.

Ok, I'm done, lol. I hope you are able to get what you need without too much more red-tape.

Jane

From: Borlik <christina_borlik@...>infantile scoliosis <infantile scoliosis treatment >Sent: Mon, October 25, 2010 11:22:31 AMSubject: RE: Insurance issues - a vent

Ugh...how frustrating for you too!

I think they want all the med recs so that they can determine how much more they will charge us. They legally can't deny us, but I don't think there are laws capping how much more they can charge us.~Noah 5 years old9 months of casting in SLC; 2 1/2 years of bracing; Currently treatment-free at 8*And Mariella 1 yr old - resolved Infantile Scoliosis

infantile scoliosis treatment From: missikay10@...Date: Sun, 24 Oct 2010 14:38:28 -0500Subject: Re: Insurance issues - a vent

Insurance just plain sucks! My husbands entire company's monthly premium went up due to isaiah's medical issues and this is before they knew about the autism which they don't cover anyway. They called my husband specifically and drilled him about his chiari malformation that has already been decompressed. And they wanted all details about his scoli even though my husband told them three times he is treated at a free hospital. And they stated something about how they wouldn't cover anything but surgery not casting anyway! So I agree with you insurance sucks! They can't deny him for a pre existing condition so why do they need med recs anyway! Borlik <christina_borlik@...> wrote:>>Just need to vent to people who will understand : )>We recently

lost

our health insurance and have had to apply for private insurance. What a nightmare! I researched the new "prior condition" reform and found out the effective date. As of 9/23 under Obama's new reform - health insurance companies can no longer deny children health insurance due to a "prior condition." (Thank goodness!) We therefore didn't apply until after 9/23 for fear of Noah being denied.>We of course disclosed that Noah had a history of scoli. We were almost immediately asked for all of his surgical records (even though we clearly marked on the application that he had never rec'd surgery for the condition.) Upon explaining this to the worker we then rec'd a letter asking for all medical records from time of diagnoisis to present day (previously we were only asked to provide the most recent.) I of course took offense to this as they obviously didn't believe me. I was told "they look at the statistics for the condition." How offensive! My son is

just a statistic.>Finally, a month later I rec'd his medical records and reviewed them. Unfortunately there were some serious errors on them. In one record is says that Noah has been treated for 6 years (impossible as he's only just 5 years old.) And in one record it referred to his curve measuring 60* in cast. Noah has never measured that high as we started treatment at 36*. I now have to wait for the doctor to revise his notes which no one will tell me when that will be. So we are going on month 3 of no health insurance.>I am bothered by this to no end. A.) My son did not have surgery and will (knock on wood) never need surgery. I don't care what their "statistics" say. B.) My son is treated at a Shriners Hospital. His scoliosis will never cost your multi-billion dollar company a penny. C.) My son technically no longer even has scoliosis and isn't even being treated right now. I did the honest thing and disclosed his "prior

condition.">Frustrated,~>Noah 5 years old>9 months of casting in SLC; 2 1/2 years of bracing; Currently treatment-free at 8*>And Mariella 1 yr old - resolved Infantile Scoliosis>>>>

[Guest guest]

Just to clarify, Shriners Hospitals' policy HAS changed with regard to billing

insurance companies.

This change was necessitated by the economic downturn of the past few years and

is something that Shriners had resisted for a long time. However, the financial

situation had become so dire that the members were faced with two options -

either bill insurance companies or close some of the hospitals. The money just

wasn't there to keep operating in the same manner and under the same guidelines

that had been in place for so many years. So, they voted to accept third-party

payment from insurance companies.

That said, whatever costs and charges one's insurance carrier doesn't pick up

will be absorbed by Shriners. THE PATIENT'S FAMILY WILL NEVER BE ASKED TO PAY A

PENNY. That hasn't changed.

Hope this helps clear things up.

>

> >

> >Just need to vent to people who will understand : )

> >We recently lost our health insurance and have had to apply for private

> >insurance. What a nightmare! I researched the new " prior condition " reform

and

> >found out the effective date. As of 9/23 under Obama's new reform - health

> >insurance companies can no longer deny children health insurance due to a

" prior

> >condition. " (Thank goodness!) We therefore didn't apply until after 9/23 for

> >fear of Noah being denied.

> >We of course disclosed that Noah had a history of scoli. We were almost

> >immediately asked for all of his surgical records (even though we clearly

marked

> >on the application that he had never rec'd surgery for the condition.) Upon

> >explaining this to the worker we then rec'd a letter asking for all medical

> >records from time of diagnoisis to present day (previously we were only asked

to

> >provide the most recent.) I of course took offense to this as they obviously

> >didn't believe me. I was told " they look at the statistics for the

condition. "

> >How offensive! My son is just a statistic.

> >Finally, a month later I rec'd his medical records and reviewed them.

> >Unfortunately there were some serious errors on them. In one record is says

that

> >Noah has been treated for 6 years (impossible as he's only just 5 years old.)

> >And in one record it referred to his curve measuring 60* in cast. Noah has

never

> >measured that high as we started treatment at 36*. I now have to wait for the

> >doctor to revise his notes which no one will tell me when that will be. So we

> >are going on month 3 of no health insurance.

> >I am bothered by this to no end. A.) My son did not have surgery and will

(knock

> >on wood) never need surgery. I don't care what their " statistics " say. B.) My

> >son is treated at a Shriners Hospital. His scoliosis will never cost your

> >multi-billion dollar company a penny. C.) My son technically no longer even

has

> >scoliosis and isn't even being treated right now. I did the honest thing and

> >disclosed his " prior condition. "

> >Frustrated,~

> >Noah 5 years old

> >9 months of casting in SLC; 2 1/2 years of bracing; Currently treatment-free

at

> >8*

> >And Mariella 1 yr old - resolved Infantile Scoliosis

> >

> >

> >

> >

>

[Guest guest]

p.s. With regard to the other point that was raised, it has always been my

understanding that insurance carriers might be billed for services provided

OUTSIDE of Shriners. For example, a test that could not be done at Shriners

because they didn't have the equipment or capability.

For that reason, since 2003 (when we first started taking my son to Shriners),

we were asked if we had insurance and for a copy of our insurance card. We were

told that WE would never be asked to pay anything but that if third parties (NOT

Shriners) provided services, they could chose to bill our insurance carrier.

For the record, we never even saw an EOB from our insurance company for anything

done outside of Shriners. For example, I know that the ton and

Providence braces are NOT made at the Shriners Hospital where we go - they are

sent out to be made. My son had braces made off-site but we never saw an EOB

for them. I am assuming that Shriners picked up the tab for any portion not

covered by our insurance carrier.

> >

> > >

> > >Just need to vent to people who will understand : )

> > >We recently lost our health insurance and have had to apply for private

> > >insurance. What a nightmare! I researched the new " prior condition " reform

and

> > >found out the effective date. As of 9/23 under Obama's new reform - health

> > >insurance companies can no longer deny children health insurance due to a

" prior

> > >condition. " (Thank goodness!) We therefore didn't apply until after 9/23

for

> > >fear of Noah being denied.

> > >We of course disclosed that Noah had a history of scoli. We were almost

> > >immediately asked for all of his surgical records (even though we clearly

marked

> > >on the application that he had never rec'd surgery for the condition.) Upon

> > >explaining this to the worker we then rec'd a letter asking for all medical

> > >records from time of diagnoisis to present day (previously we were only

asked to

> > >provide the most recent.) I of course took offense to this as they

obviously

> > >didn't believe me. I was told " they look at the statistics for the

condition. "

> > >How offensive! My son is just a statistic.

> > >Finally, a month later I rec'd his medical records and reviewed them.

> > >Unfortunately there were some serious errors on them. In one record is says

that

> > >Noah has been treated for 6 years (impossible as he's only just 5 years

old.)

> > >And in one record it referred to his curve measuring 60* in cast. Noah has

never

> > >measured that high as we started treatment at 36*. I now have to wait for

the

> > >doctor to revise his notes which no one will tell me when that will be. So

we

> > >are going on month 3 of no health insurance.

> > >I am bothered by this to no end. A.) My son did not have surgery and will

(knock

> > >on wood) never need surgery. I don't care what their " statistics " say. B.)

My

> > >son is treated at a Shriners Hospital. His scoliosis will never cost your

> > >multi-billion dollar company a penny. C.) My son technically no longer even

has

> > >scoliosis and isn't even being treated right now. I did the honest thing

and

> > >disclosed his " prior condition. "

> > >Frustrated,~

> > >Noah 5 years old

> > >9 months of casting in SLC; 2 1/2 years of bracing; Currently

treatment-free at

> > >8*

> > >And Mariella 1 yr old - resolved Infantile Scoliosis

> > >

> > >

> > >

> > >

> >

>

[Guest guest]

We got charged multiple times for anesthesia at Primary in SLC. Got

charged for an ambulance ride once too! But, they (Shriners)ended up

taking care of that for us. Thank goodness.

Gotta love em.

HRH

> I have never been billed for something that happened at a Shriner's

> facility.

> But, they have asked me to have testing done outside of their facility

> and

> ordered by our pediatrician. I wasn't saying Shriner's billed us.

>

> Jane

>

>

>

>

> ________________________________

> From: NIck Guthe <nickguthe@...>

> infantile scoliosis treatment

> Sent: Tue, October 26, 2010 7:31:01 PM

> Subject: Re: Insurance issues - a vent

>

>

> Just to chime in, we went for an MRI at Primary Children's in SLC and they

> did

> bill our insurance. We've never been billed for anything at Shriners, nor

> has

> our insurance. Not sure if policy has changed? We chose to get it done

> there (in

> SLC versus here in L.A.) to avoid longer out of cast time- it was only 2

> days

> this way. Shriners may pick it up if you are not covered, ours was.

>

> Heidi, Bexon's Mommy, (3 years old, in 6th cast from Salt Lake City

> Shriners,

> currently down from 62 degrees to 20 in cast)

>

>

>

>

> ________________________________

> From: Borlik <christina_borlik@...>

> infantile scoliosis <infantile scoliosis treatment >

> Sent: Tue, October 26, 2010 11:36:48 AM

> Subject: RE: Insurance issues - a vent

>

>

> Hi Jane,

> Thanks for sharing. I did want to add though that each Shriner's hospital

> must

> do things a little differently then. When Noah was seen at Shriners

> Chicago

> they ordered an MRI for him at a local children's hospital since they

> didn't

> have MRI capabilities. They took my insurance info and said they would

> submit

> to my inusrance and then whatever my insurance did not pay - they would

> cover.

> My insurance paid 80% of the MRI and Shriners paid the remaining 20%.

>

> When Noah was treated at Salt Lake City Shriners and needed another MRI

> they

> again ordered it at a local children's hospital. SLC did not take my

> insurance

> info and nothing was ever submitted. I was told that the Shriner's took

> care of

> it all. I did ask my care coordinator why they wouldn't submit to our

> insurance

> so that they would at least pick up a portion of the bill and she said

> they

> simply choose not to employ a billing dept. to keep their expenses down.

>

> So, in both cases I never paid a penny. I am very grateful for this

> because we

> have been paying for all travel (flights, hotels, food etc.) on our own

> for the

> last 3 1/2 years and that's an expensive enough medical expense.

>

> PS - Very disturbed by your cath experience. Shame on them!

>

> ~

> Noah 5 years old

> 9 months of casting in SLC; 2 1/2 years of bracing; Currently

> treatment-free at

> 8*

> And Mariella 1 yr old - resolved Infantile Scoliosis

>

>

>

>

>

> ________________________________

> infantile scoliosis treatment

> From: janemhar@...

> Date: Mon, 25 Oct 2010 11:43:42 -0700

> Subject: Re: Insurance issues - a vent

>

>

>

>

> I don't know about the hospital's you guys go to, but here in Portland at

> Shriner's, there is still certain things they don't cover and do ask that

> you

> have back-up insurance for those things. For example, CT's, MRI's, and

> whatnot. In addition, IF your child was to need surgery, and there were

> things

> that the " free hospital " doesn't cover, again, your insurance would be

> expected

> to cover it. When Grace had her spine surgery, our Shriner's doesn't have

> a

> Pediatric ICU, so she was transferred for 24 hours to the local children's

> hospital nearby for PICU services. This was not covered by Shriner's, but

> instead was covered by my medical insurance. Shriner's did however pay

> the

> co-pay I would have been required to pay.

>

> I'm not standing up for the insurance companies, I think a lot of things

> are

> crappy when it comes to coverage or the lack there of for medically

> necessary

> treatment, but I'm sure they feel they need to know up front what someone

> has and look at the potential long term needs. Also kids are now covered

> by a

> parent's insurance until what, the age of 25? And most of the " free "

> hospitals,

> (again, at least Shriner's) ends services at 18, so your insurance, if you

> have

> it that long, will end up being the responsible party.

>

> That said, I just got denied life insurance due to my weight. My weight

> is my

> ONLY issue. I don't have high cholesterol, high bp, diabetes, etc.

> NOTHING,

> and I got denied. In addition, a lot of companies won't cover catheters

> for

> kids who need intermittent cathing (like what Grace would need if we

> weren't

> going to get the Mitrofanoff done in the next year). Some only cover 2

> (!) per

> month, for kids that need cathing 4-6 times a DAY. It is a proven fact

> that re-using caths is a big cause for repeat infections (and in our case

> the

> reason we would be cathing is to avoid infections in the first place),

> which diagnostics and treatment of an infection is extraordinarily higher

> than

> just covering the cost of single-use caths. Go figure. And that is an

> issue

> outside of what Shriner's deals with, that is related to her other

> anomalies,

> that my insurance will need to do something about.

>

> I guess what I'm trying to say, is our kids are one whole being, and I

> know at

> least for us, we can't get our services in " one stop shopping " at one

> hospital

> or clinic. So a piece of me understands why the insurance needs to see

> the big

> picture.

>

> Ok, I'm done, lol. I hope you are able to get what you need without too

> much

> more red-tape.

>

> Jane

>

>

>

>

> ________________________________

> From: Borlik <christina_borlik@...>

> infantile scoliosis <infantile scoliosis treatment >

> Sent: Mon, October 25, 2010 11:22:31 AM

> Subject: RE: Insurance issues - a vent

>

>

> Ugh...how frustrating for you too!

>

>

> I think they want all the med recs so that they can determine how much

> more they

> will charge us. They legally can't deny us, but I don't think there are

> laws

> capping how much more they can charge us.

>

> ~

> Noah 5 years old

> 9 months of casting in SLC; 2 1/2 years of bracing; Currently

> treatment-free at

> 8*

> And Mariella 1 yr old - resolved Infantile Scoliosis

>

>

>

>

>

> ________________________________

> infantile scoliosis treatment

> From: missikay10@...

> Date: Sun, 24 Oct 2010 14:38:28 -0500

> Subject: Re: Insurance issues - a vent

>

>

> Insurance just plain sucks! My husbands entire company's monthly premium

> went up

> due to isaiah's medical issues and this is before they knew about the

> autism

> which they don't cover anyway. They called my husband specifically and

> drilled

> him about his chiari malformation that has already been decompressed. And

> they

> wanted all details about his scoli even though my husband told them three

> times

> he is treated at a free hospital. And they stated something about how they

> wouldn't cover anything but surgery not casting anyway! So I agree with

> you

> insurance sucks! They can't deny him for a pre existing condition so why

> do they

> need med recs anyway!

>

>

> Borlik <christina_borlik@...> wrote:

>

>>

>>Just need to vent to people who will understand : )

>>We recently lost our health insurance and have had to apply for private

>>insurance. What a nightmare! I researched the new " prior condition "

>> reform and

>>found out the effective date. As of 9/23 under Obama's new reform -

>> health

>>insurance companies can no longer deny children health insurance due to a

>> " prior

>>condition. " (Thank goodness!) We therefore didn't apply until after 9/23

>> for

>>fear of Noah being denied.

>>We of course disclosed that Noah had a history of scoli. We were almost

>>immediately asked for all of his surgical records (even though we clearly

>> marked

>>on the application that he had never rec'd surgery for the condition.)

>> Upon

>>explaining this to the worker we then rec'd a letter asking for all

>> medical

>>records from time of diagnoisis to present day (previously we were only

>> asked to

>>provide the most recent.) I of course took offense to this as they

>> obviously

>>didn't believe me. I was told " they look at the statistics for the

>> condition. "

>>How offensive! My son is just a statistic.

>>Finally, a month later I rec'd his medical records and reviewed them.

>>Unfortunately there were some serious errors on them. In one record is

>> says that

>>Noah has been treated for 6 years (impossible as he's only just 5 years

>> old.)

>>And in one record it referred to his curve measuring 60* in cast. Noah

>> has never

>>measured that high as we started treatment at 36*. I now have to wait for

>> the

>>doctor to revise his notes which no one will tell me when that will be.

>> So we

>>are going on month 3 of no health insurance.

>>I am bothered by this to no end. A.) My son did not have surgery and will

>> (knock

>>on wood) never need surgery. I don't care what their " statistics " say.

>> B.) My

>>son is treated at a Shriners Hospital. His scoliosis will never cost your

>>multi-billion dollar company a penny. C.) My son technically no longer

>> even has

>>scoliosis and isn't even being treated right now. I did the honest thing

>> and

>>disclosed his " prior condition. "

>>Frustrated,~

>>Noah 5 years old

>>9 months of casting in SLC; 2 1/2 years of bracing; Currently

>> treatment-free at

>>8*

>>And Mariella 1 yr old - resolved Infantile Scoliosis

>>

>>

>>

>>

>

>

>

>

>

>

>

>