Guest guest Posted August 11, 2003 Report Share Posted August 11, 2003 We went ahead and banded Ian before we got approval. I did however make sure we submitted all the information needed to start the precertification process (so that the ins. co. could say we didnt approch it right. We were fortunate enough to have some money to help us start treatment. Ian was 1 week from graduating when we heard the news from our insurance company that they were going to pay. Ian was banded at 6 months and wore his band for 11 weeks. I know that if we waited around for the ins. co. that he probably would have had to wear the band for a longer period of time due to his age. Good luck in making your decision. Kate Mom to Ian (DOCgrad 5/03) Northern VA > Hello! I have noticed that several of you got good news about your > insurance coming through with payment recently. That's great!!! > > Makes me wonder...we haven't gotten approval yet. Should we jump in > and get the helmet done, then request reimbursement if they approve? > Or should we play the waiting game and see if they approve, THEN get > the helmet? I know time is of the essence...she's 6 1/2 months now. > > What did you all do? > > -Krista > Lake Forest, CA > SO happy to have found this place!!!!!!!! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 11, 2003 Report Share Posted August 11, 2003 Krista, We went through the whole, painfully slow, precertification process (btw, was just about 5 months when she was banded). As much as it drove me crazy, I think it made a big difference in UHC paying. Our ped even spoke directly with their claims director who was determining whether or not to pay. Good luck!!! Kerri 's mom (DOCgrad) > Hello! I have noticed that several of you got good news about your > insurance coming through with payment recently. That's great!!! > > Makes me wonder...we haven't gotten approval yet. Should we jump in > and get the helmet done, then request reimbursement if they approve? > Or should we play the waiting game and see if they approve, THEN get > the helmet? I know time is of the essence...she's 6 1/2 months now. > > What did you all do? > > -Krista > Lake Forest, CA > SO happy to have found this place!!!!!!!! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 11, 2003 Report Share Posted August 11, 2003 We went ahead and got my son's helmet when he was 5 months because there head grows so much before the 7 month mark, my son only had to wear it for 10 weeks and I am now starting to appeal with my insurance company. Good Luck, shannon152000 <wolfekm@...> wrote: Krista,We went through the whole, painfully slow, precertification process (btw, was just about 5 months when she was banded). As much as it drove me crazy, I think it made a big difference in UHC paying. Our ped even spoke directly with their claims director who was determining whether or not to pay. Good luck!!!Kerri's mom (DOCgrad)> Hello! I have noticed that several of you got good news about your > insurance coming through with payment recently. That's great!!! > > Makes me wonder...we haven't gotten approval yet. Should we jump in > and get the helmet done, then request reimbursement if they approve? > Or should we play the waiting game and see if they approve, THEN get > the helmet? I know time is of the essence...she's 6 1/2 months now.> > What did you all do?> > -Krista> Lake Forest, CA> SO happy to have found this place!!!!!!!! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 11, 2003 Report Share Posted August 11, 2003 We went for the pre-approval, but were quickly denied. We did go ahead and band Trentyn while we were appealing and now after 8 weeks it is paid. I know that you need to at least try to get pre-certified because they can deny you for not following the proper procedure. Luckily, you do still have time on your side. Good luck! Jen- TXTrentyn- 15 mo. DocBand 06/12/03 Question about insurance Hello! I have noticed that several of you got good news about your insurance coming through with payment recently. That's great!!! :)Makes me wonder...we haven't gotten approval yet. Should we jump in and get the helmet done, then request reimbursement if they approve? Or should we play the waiting game and see if they approve, THEN get the helmet? I know time is of the essence...she's 6 1/2 months now.What did you all do?-KristaLake Forest, CASO happy to have found this place!!!!!!!!For more plagio info Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 11, 2003 Report Share Posted August 11, 2003 Hi Krista: We also waited for the predetermination denial before we proceeded with the band. CT recommended that we follow the insurance policy to cover all bases. Are you waiting for their decision? I would call them every other day to find out the status...usually this type of predetermination could be considered urgent because it is time sensitive. Just remember the squeaky wheel gets the oil We are at appeal #1 and waiting for their decision. Good luck and hopefully your insurance company will do the right thing and just show CT the money! Lori and on docbanded 6/23/03 > Hello! I have noticed that several of you got good news about your > insurance coming through with payment recently. That's great!!! > > Makes me wonder...we haven't gotten approval yet. Should we jump in > and get the helmet done, then request reimbursement if they approve? > Or should we play the waiting game and see if they approve, THEN get > the helmet? I know time is of the essence...she's 6 1/2 months now. > > What did you all do? > > -Krista > Lake Forest, CA > SO happy to have found this place!!!!!!!! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 11, 2003 Report Share Posted August 11, 2003 We went ahead and banded before insurance approval. I'm really glad I did because it took Cigna PPO 7 months to decide to deny us. Our orthotist's office was really nice and didn't ask for ANY money until the denial of our first appeal, which was a year later. They reduced our cost and let us pay in 3 payments of $660 each. Luckily the year they gave us to wait for the approval/denial gave us time to save up for the payments. & (16 months, STARband Grad) > Hello! I have noticed that several of you got good news about your > insurance coming through with payment recently. That's great!!! > > Makes me wonder...we haven't gotten approval yet. Should we jump in > and get the helmet done, then request reimbursement if they approve? > Or should we play the waiting game and see if they approve, THEN get > the helmet? I know time is of the essence...she's 6 1/2 months now. > > What did you all do? > > -Krista > Lake Forest, CA > SO happy to have found this place!!!!!!!! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 8, 2005 Report Share Posted July 8, 2005 Are insurance companies so technical that they will see the Walmart prescription of naltrexone at 4.5 where they gave me three pills per month that they will know if the doc writes one out for 30 that I'm trying to get more? I called Walmart to have then take off the 3 pill prescription and she said she can't but can put it on hold for a year. I told her I was trying to get another script and I didn't want that one since I can't get two scripts of the same med in one month. Still don't have the script filled where I called them this morning to see if they could try 30 pills and reword the taking it info. Now I wonder if I screwed up b/c the Walmart script said dissolve 50mgs put in 50mls and take 4.5mgs so will the insurance know I'm trying to get more? How do they know the doc hasn't raised my dose and I could have been trying a low dose to see if I tolerate the drug. I've heard nothing back all day and I called Eckerds at lunch and they said it was filled and I get there and they say no one has called in anything. That was so Weird and it's like I'm trying to get an illegal drug and I'm about to give up if now my insurance knows. Anybody know this? Still have Mexico and Skips but the cheaper is better for me. I'm glad I have some on hand. Guess I can just go the 3 a month way and pay $100 for 10 months. That would be like from Mexico but get it here. RC Quote Link to comment Share on other sites More sharing options...
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