Insurance

[Guest guest]

I was told there would cover some of it, How ever i

don't have it we make to much to get it

!!

--- <b_mcdowell02@...> wrote:

>

> I was just wondering if state insurance (medicaid)

> would pay for any

> of the helmet?

>

>

>

>

__________________________________________________

[Guest guest]

I was told there would cover some of it, How ever i

don't have it we make to much to get it

!!

--- <b_mcdowell02@...> wrote:

>

> I was just wondering if state insurance (medicaid)

> would pay for any

> of the helmet?

>

>

>

>

__________________________________________________

[Guest guest]

I'd call too, but you can also check our insurance database to see how

anyone else's experiences may have been. Good luck.

, mom to Hannah, DOCgrad

Cape Cod, Ma

http://hannahsnoggin.typepad.com

--- In Plagiocephaly , " " <b_mcdowell02@y...>

wrote:

>

> I was just wondering if state insurance (medicaid) would pay for any

> of the helmet?

[Guest guest]

I hear ya, I sooooo wish that for all parents here! )

Re: Kylie will be banded next week!!That is awesome that BCBS are paying 100% afterdeductible. Such a relief. --- julie <jdebolt@...> wrote:> wrote:> > at MFB they have the starscanner - so instead of> getting a plaster cast done of the head to make the> band - they just put a little sock over the head,> lay them in this little scnner box, and boom 30> seconds later you have a 3-D laser cast of the head.> They will put a 1-d type of scan on paper for you -> so it's like a top down view. Then they will do> scans every so often so that you can see the> progress on paper. It's cool!> > So now I missed it I see you went yesterday - how> did it go???> > > > > > > I soooo wanted to talk with someone on the phone> yesterday! ugh. I was as MFB for five hours with my> little one! I was so tired and confused and kindof> overwhelmed. Anyway,> PT eval, OT eval were first. She has mild tort with> some other issues going on.....weakness, weight> shifting and some hip rotation etc. They put her on> a tort program which will include some CST!! I am> so geeked about that! > Over at the othotist they did the starscanner. I> wish that I could have gotten your post before I> went LOL I told the " resident " orthotist after the> scan.....that the scan was probably easy...compared> to the casting that came next. LOL He did look at> me funny..and then chuckled and agreed. Geeez,> shows what I know. ) And I wondered why he> wasn't going to schedule me to come back sooner to> cast....he just said they would order the helmet and> it should be in next week or so. Thank you for> clarifying that for me. BTW, she has a combination> of mild plagio/moderate brachy. He anticipates with> her age (9.5mo) she may be in as long as 11 months.> ack! But he doesn't anticipate she will need to be> banded a second time. YEAH! GROW KYLIE! (now I> understand that phrase!!!) ) And the best news> for last....BCBS agreed and gave the go ahead to> cover the expenses 100% after our deductable has> been met!!!!!!!! What a relief! If I can help> anyone on that front, just let me know. > jdebolt@... > ~julie> -> > > > > > > ~, mommy to> Kylie Jo 9mo. tort/plagio > E.J 9mo. tort resolved> and seven other busy children....> ____________________________________________________ Sports Rekindle the Rivalries. Sign up for Fantasy Football http://football.fantasysports.For more plagio info

[Guest guest]

Wow Debbie, That's awesome! That's just one more reason to go for it

and do the band! I mean at least it's free right??!! lol!

Lacy

--- In Plagiocephaly , " Deborah B " <aguinesslover@h...>

wrote:

> Just to let you know Oxford Health plan said they would cover 100% of

> the band and it only took them a day to give me an answer. Either they

> are good or my pediatricians letter was really good. We are really

> lucky. Debbie

[Guest guest]

Wow Debbie, That's awesome! That's just one more reason to go for it

and do the band! I mean at least it's free right??!! lol!

Lacy

--- In Plagiocephaly , " Deborah B " <aguinesslover@h...>

wrote:

> Just to let you know Oxford Health plan said they would cover 100% of

> the band and it only took them a day to give me an answer. Either they

> are good or my pediatricians letter was really good. We are really

> lucky. Debbie

[Guest guest]

Very lucky!! Yeah! One less worry.

mom to na (2 yr) DOC Grad & Kiersten (6 weeks) Preventative Repo

www.thefilyaws.comDeborah B <aguinesslover@...> wrote:

Just to let you know Oxford Health plan said they would cover 100% of the band and it only took them a day to give me an answer. Either they are good or my pediatricians letter was really good. We are really lucky. DebbieFor more plagio info

[Guest guest]

Very lucky!! Yeah! One less worry.

mom to na (2 yr) DOC Grad & Kiersten (6 weeks) Preventative Repo

www.thefilyaws.comDeborah B <aguinesslover@...> wrote:

Just to let you know Oxford Health plan said they would cover 100% of the band and it only took them a day to give me an answer. Either they are good or my pediatricians letter was really good. We are really lucky. DebbieFor more plagio info

[Guest guest]

One of the things that we did is never had my husband actually diagnosed as

having MS, because we did not want the medical insurance companies to deny

us insurance. We pay for everything in cash that is directly related to MS.

Now that my husband has LDN there are very few bills any more.

Aletha

[low dose naltrexone] insurance

>I know this is somewhat off-topic for the 'low dose naltrexone' group, but

> it is MS and in general chronic disease related. Health insurance, of

> course, is a real struggle, to say the least. My wife, , and I are

> moving to a different state of the US and will have to find new

> insurance (long story why). She, thankfully, is still able to work and

> prefers to work. LDN has a significant role in keeping her as active as

> she wants to be. She's 37, so medicare doesn't apply. We make too much

> money for medicaid and prefer not to use a subsidized program so long as

> we are both able bodied and can afford not to, not a political

> statement, just a preference to leave those funds for those who need

> them more than we.

>

> What do others do for private insurance, especially those who are

> self-employed? Thanks for any replies.

>

>

>

>

>

>

[Guest guest]

Barb,

We have United Healthcare PPO, and it is about the only insurance Dr. G accepts

(unless I have old info.). Most, if not all of the " " meds we've been on

have been covered to a certain degree. It's best if you can go generic. With

our plan, we have a co-pay, and UHC pays a certain percentage of the drugs'

cost. So it would depend how much the individual medication runs. Some can be

less than $10; valtrex runs us almost $200/mo AFTER the insurance!

Dr. G office visits are covered with a $25 co-pay (phone consults are not). Our

neurospect was covered with a $35 co-pay. There are different plans within UHC,

so you would need to check the details of the specific plan you're on .

HTH,

Heidi

insurance

I just found out that our insurance plan (a small

group plan thru my husband's business) was bought out

and will be managed by United Health Care. Does

anyone have any experience dealing with them and

getting nids type meds, etc. covered with this

company?

Barb Katsaros

barbkatsaros@...

__________________________________

- PC Magazine Editors' Choice 2005

http://mail.

[Guest guest]

Thanks so much for your input. That reassures me

somewhat. Our insurance plan with our present co. is

much different than that. I'm hoping it doesn't

change too much. I'm just picturing them wanting the

same amt. in premiums but giving us less! (We are

privately insured.)

--- Heidi Kaufmann <HeidiKaufmann908@...> wrote:

> Barb,

> We have United Healthcare PPO, and it is about the

> only insurance Dr. G accepts (unless I have old

> info.). Most, if not all of the " " meds we've

> been on have been covered to a certain degree. It's

> best if you can go generic. With our plan, we have

> a co-pay, and UHC pays a certain percentage of the

> drugs' cost. So it would depend how much the

> individual medication runs. Some can be less than

> $10; valtrex runs us almost $200/mo AFTER the

> insurance!

>

> Dr. G office visits are covered with a $25 co-pay

> (phone consults are not). Our neurospect was

> covered with a $35 co-pay. There are different

> plans within UHC, so you would need to check the

> details of the specific plan you're on .

>

> HTH,

> Heidi

>

> insurance

>

> I just found out that our insurance plan (a small

> group plan thru my husband's business) was bought

> out

> and will be managed by United Health Care. Does

> anyone have any experience dealing with them and

> getting nids type meds, etc. covered with this

> company?

>

> Barb Katsaros

> barbkatsaros@...

>

>

>

> __________________________________

> - PC Magazine Editors' Choice 2005

> http://mail.

>

>

>

[Guest guest]

They've been pretty good to cover meds so far. Though, they don't

cover things like testing etc.

> I just found out that our insurance plan (a small

> group plan thru my husband's business) was bought out

> and will be managed by United Health Care. Does

> anyone have any experience dealing with them and

> getting nids type meds, etc. covered with this

> company?

>

> Barb Katsaros

> barbkatsaros@y...

>

>

>

> __________________________________

> - PC Magazine Editors' Choice 2005

> http://mail.

[Guest guest]

Kim,

Check out the files section. Why are they denying you?

--- In Plagiocephaly , " kimanninc " <kimanninc@y...>

wrote:

>

> Does anyone have any info about how to get insurance to cover Doc

> Band... I have Horizon BCBSNJ They already denied my first appeal...

My

> second Level appeal is going to be the 30th if anyone has any info

> Please email me Kimm3737@a... Thank you--Kim

>

[Guest guest]

Kim,

Check out the files section. Why are they denying you?

--- In Plagiocephaly , " kimanninc " <kimanninc@y...>

wrote:

>

> Does anyone have any info about how to get insurance to cover Doc

> Band... I have Horizon BCBSNJ They already denied my first appeal...

My

> second Level appeal is going to be the 30th if anyone has any info

> Please email me Kimm3737@a... Thank you--Kim

>

[Guest guest]

HI Amy, I am far from an expert on health insurance but we have UHC and we were expecting to be denied but were not. They paid 80% after a the deductible. All I did was fill out and submit the paperwork CT sent me along with pictures. My pediatrician told me that the insurance company called her and she fought for us also. Technically we have THE EMPIRE PLAN which is NY state's plan for government employees. I don't szee why they would cover for ne and not the other. It should be covered under the durable medical supplies. I don't know where to tell you to go from here but let me know if I can help. Good luck, Meagancally2424 <cally2424@...> wrote: Hi everyone! We just received notice that our appeal to our

insurance company (UnitedHealthCare) has been denied to cover our son's helmet. I know that there is a lot of information available on this site in the files on insurance help. I utilized much of it during the first appeal which was 15 pages long. What I am wondering now is what is my next option? Our insurance company denied on the basis that orthotic devices just simply are not covered. Has anyone had experience with this and been succesful? Specifically, has anyone recently been successful in fighting a denial against UnitedHealthCare? Thanks for any help that you can give me.Amy

Photos Got holiday prints? See all the ways to get quality prints in your hands ASAP.

[Guest guest]

HI Amy, I am far from an expert on health insurance but we have UHC and we were expecting to be denied but were not. They paid 80% after a the deductible. All I did was fill out and submit the paperwork CT sent me along with pictures. My pediatrician told me that the insurance company called her and she fought for us also. Technically we have THE EMPIRE PLAN which is NY state's plan for government employees. I don't szee why they would cover for ne and not the other. It should be covered under the durable medical supplies. I don't know where to tell you to go from here but let me know if I can help. Good luck, Meagancally2424 <cally2424@...> wrote: Hi everyone! We just received notice that our appeal to our

insurance company (UnitedHealthCare) has been denied to cover our son's helmet. I know that there is a lot of information available on this site in the files on insurance help. I utilized much of it during the first appeal which was 15 pages long. What I am wondering now is what is my next option? Our insurance company denied on the basis that orthotic devices just simply are not covered. Has anyone had experience with this and been succesful? Specifically, has anyone recently been successful in fighting a denial against UnitedHealthCare? Thanks for any help that you can give me.Amy

Photos Got holiday prints? See all the ways to get quality prints in your hands ASAP.

[Guest guest]

Hi Amy,

I don't have any advice for you, sorry. I just wanted to wish you good

luck. Don't give up! Keep us posted.

>

> Hi everyone! We just received notice that our appeal to our insurance

> company (UnitedHealthCare) has been denied to cover our son's helmet.

> I know that there is a lot of information available on this site in the

> files on insurance help. I utilized much of it during the first appeal

> which was 15 pages long. What I am wondering now is what is my next

> option? Our insurance company denied on the basis that orthotic

> devices just simply are not covered.

> Has anyone had experience with this and been succesful? Specifically,

> has anyone recently been successful in fighting a denial against

> UnitedHealthCare?

> Thanks for any help that you can give me.

> Amy

>

[Guest guest]

Hi Amy,

I don't have any advice for you, sorry. I just wanted to wish you good

luck. Don't give up! Keep us posted.

>

> Hi everyone! We just received notice that our appeal to our insurance

> company (UnitedHealthCare) has been denied to cover our son's helmet.

> I know that there is a lot of information available on this site in the

> files on insurance help. I utilized much of it during the first appeal

> which was 15 pages long. What I am wondering now is what is my next

> option? Our insurance company denied on the basis that orthotic

> devices just simply are not covered.

> Has anyone had experience with this and been succesful? Specifically,

> has anyone recently been successful in fighting a denial against

> UnitedHealthCare?

> Thanks for any help that you can give me.

> Amy

>

[Guest guest]

Amy,

Can you get the specific wording on the orthotic exclusion? You may

be able to find a way around the exclusion. It could be an exclusion

for braces and such.

Kiersten, 8 months, DOC Band 1/10/06, Tort

na, 2 1/2 yrs, DOC Grad Feb 04, Tort Resolved

www.thefilyaws.com

--- In Plagiocephaly , " cally2424 " <cally2424@y...>

wrote:

>

> Hi everyone! We just received notice that our appeal to our

insurance

> company (UnitedHealthCare) has been denied to cover our son's

helmet.

> I know that there is a lot of information available on this site in

the

> files on insurance help. I utilized much of it during the first

appeal

> which was 15 pages long. What I am wondering now is what is my

next

> option? Our insurance company denied on the basis that orthotic

> devices just simply are not covered.

> Has anyone had experience with this and been succesful?

Specifically,

> has anyone recently been successful in fighting a denial against

> UnitedHealthCare?

> Thanks for any help that you can give me.

> Amy

>

[Guest guest]

Amy,

Can you get the specific wording on the orthotic exclusion? You may

be able to find a way around the exclusion. It could be an exclusion

for braces and such.

Kiersten, 8 months, DOC Band 1/10/06, Tort

na, 2 1/2 yrs, DOC Grad Feb 04, Tort Resolved

www.thefilyaws.com

--- In Plagiocephaly , " cally2424 " <cally2424@y...>

wrote:

>

> Hi everyone! We just received notice that our appeal to our

insurance

> company (UnitedHealthCare) has been denied to cover our son's

helmet.

> I know that there is a lot of information available on this site in

the

> files on insurance help. I utilized much of it during the first

appeal

> which was 15 pages long. What I am wondering now is what is my

next

> option? Our insurance company denied on the basis that orthotic

> devices just simply are not covered.

> Has anyone had experience with this and been succesful?

Specifically,

> has anyone recently been successful in fighting a denial against

> UnitedHealthCare?

> Thanks for any help that you can give me.

> Amy

>

[Guest guest]

I have made several attempts at obtaining the specific wording of the

plan in writing but no one seems to want to give that to me. I have

contacted my husband's employer and they referred me to the insurance

company. The insurance company says that they don't have it. It's

so frustrating. Any suggestions?

> >

> > Hi everyone! We just received notice that our appeal to our

> insurance

> > company (UnitedHealthCare) has been denied to cover our son's

> helmet.

> > I know that there is a lot of information available on this site

in

> the

> > files on insurance help. I utilized much of it during the first

> appeal

> > which was 15 pages long. What I am wondering now is what is my

> next

> > option? Our insurance company denied on the basis that orthotic

> > devices just simply are not covered.

> > Has anyone had experience with this and been succesful?

> Specifically,

> > has anyone recently been successful in fighting a denial against

> > UnitedHealthCare?

> > Thanks for any help that you can give me.

> > Amy

> >

>

[Guest guest]

I have made several attempts at obtaining the specific wording of the

plan in writing but no one seems to want to give that to me. I have

contacted my husband's employer and they referred me to the insurance

company. The insurance company says that they don't have it. It's

so frustrating. Any suggestions?

> >

> > Hi everyone! We just received notice that our appeal to our

> insurance

> > company (UnitedHealthCare) has been denied to cover our son's

> helmet.

> > I know that there is a lot of information available on this site

in

> the

> > files on insurance help. I utilized much of it during the first

> appeal

> > which was 15 pages long. What I am wondering now is what is my

> next

> > option? Our insurance company denied on the basis that orthotic

> > devices just simply are not covered.

> > Has anyone had experience with this and been succesful?

> Specifically,

> > has anyone recently been successful in fighting a denial against

> > UnitedHealthCare?

> > Thanks for any help that you can give me.

> > Amy

> >

>

[Guest guest]

If you are anything like us, our exclusion just says " Cranial

Banding " , nothing else. How do you fight that? I'm trying to dig

deeper with Humana to find out why it is excluded. Do they think

it's not a medically necessary thing? I guess that's what I'll have

to assume in order to fight them. They don't make this easy to

interpret, which is why they get away with murder!

> >

> > Hi everyone! We just received notice that our appeal to our

> insurance

> > company (UnitedHealthCare) has been denied to cover our son's

> helmet.

> > I know that there is a lot of information available on this site

in

> the

> > files on insurance help. I utilized much of it during the first

> appeal

> > which was 15 pages long. What I am wondering now is what is my

> next

> > option? Our insurance company denied on the basis that orthotic

> > devices just simply are not covered.

> > Has anyone had experience with this and been succesful?

> Specifically,

> > has anyone recently been successful in fighting a denial against

> > UnitedHealthCare?

> > Thanks for any help that you can give me.

> > Amy

> >

>

[Guest guest]

If you are anything like us, our exclusion just says " Cranial

Banding " , nothing else. How do you fight that? I'm trying to dig

deeper with Humana to find out why it is excluded. Do they think

it's not a medically necessary thing? I guess that's what I'll have

to assume in order to fight them. They don't make this easy to

interpret, which is why they get away with murder!

> >

> > Hi everyone! We just received notice that our appeal to our

> insurance

> > company (UnitedHealthCare) has been denied to cover our son's

> helmet.

> > I know that there is a lot of information available on this site

in

> the

> > files on insurance help. I utilized much of it during the first

> appeal

> > which was 15 pages long. What I am wondering now is what is my

> next

> > option? Our insurance company denied on the basis that orthotic

> > devices just simply are not covered.

> > Has anyone had experience with this and been succesful?

> Specifically,

> > has anyone recently been successful in fighting a denial against

> > UnitedHealthCare?

> > Thanks for any help that you can give me.

> > Amy

> >

>

[Guest guest]

Amy,

Here is one route:

Check your Summary Plan Description to see how many times you can appeal. In my

case,

it was 2. Once you've followed UHC's guidelines, in many states, you can

request an

independent review from the state insurance commission. (This is a well-kept

secret.)

Independent Review is supposed to be an outside committee of professionals who

review

the case, which is far more than UHC does. In my state, UHC will have to pay

$1000 for

this process. They're taking a gamble; it's still less of an expense to them

than the cost of

the band. Most people give up before the independent review stage. I'm just

beginning

independent review so I don't know if it will work but I'll keep the board

informed.

Good luck.

in Atlanta

>

> Hi everyone! We just received notice that our appeal to our insurance

> company (UnitedHealthCare) has been denied to cover our son's helmet.

> I know that there is a lot of information available on this site in the

> files on insurance help. I utilized much of it during the first appeal

> which was 15 pages long. What I am wondering now is what is my next

> option? Our insurance company denied on the basis that orthotic

> devices just simply are not covered.

> Has anyone had experience with this and been succesful? Specifically,

> has anyone recently been successful in fighting a denial against

> UnitedHealthCare?

> Thanks for any help that you can give me.

> Amy

>