Guest guest Posted October 6, 2000 Report Share Posted October 6, 2000 My nephew has recently been diagnosed with plagio. My sister is now going round and round with the insurance company. Is anyone on this group familiar with the appeals process? Any input would be greatly appreciated. Thank you...... Sue Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 6, 2000 Report Share Posted October 6, 2000 Sue, If you haven't already done so, check out the files section - there's some appeal info on there, together with some appeal letters that were successful. We were lucky - our ins. co. approved 's band immediately, without a fight. I'm sure you'll get some responses from parents who have won their appeals, but in the meantime check out the info in the files section. Sedlak wrote: > > My nephew has recently been diagnosed with plagio. My sister is now > going round and round with the insurance company. Is anyone on this > group familiar with the appeals process? Any input would be greatly > appreciated. > > Thank you...... > > Sue > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 9, 2001 Report Share Posted February 9, 2001 Yes, we paid up front the day we got the prescription, so as far as I know it still hasnt' been authorized. we have a point of service though.. Why dont' you call your insurance co and see if they have anything to say on it. diane tamishaver@... wrote: > I could use some advice please. Has anyone gone ahead and started > the casting process etc. without yet receiving insurance > authorization. We are due to get casted on Monday but our insurance > has not yet given authorization. My neurosurgeons secretary tells me > it will be okay to go ahead with it. She says they should > definately authorize it (they have before for other patients they > have) and she tells me the date will be the date they sent the > referral to the insurance company. She says they will still cover > even if I start before it is actually authorized. This makes me very > nervous. I plan on paying even if my insurance doesn't but I don't > want to blow it if they will. I have Cigna but it is contracted out > to Hills Physician. It's confusing. > > Thank you, > Tami and Luke > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 9, 2001 Report Share Posted February 9, 2001 Tami: We went ahead with casting without knowing what our insurance company would do and luckily they covered everything 100% (even though it was out of network). Do call your insurance company/benefits coordinator and ask if there is a penalty for starting any non-emergency treatment without authorization. Make sure you have the answer in writing. Some companies will refuse to pay if the treatment has not been authorized. Sue Luck mom to , DOC band graduate Cleveland, OH ----- Original Message ----- From: <tamishaver@...> <Plagiocephaly > Sent: Thursday, February 08, 2001 7:05 PM Subject: insurance question > I could use some advice please. Has anyone gone ahead and started > the casting process etc. without yet receiving insurance > authorization. We are due to get casted on Monday but our insurance > has not yet given authorization. My neurosurgeons secretary tells me > it will be okay to go ahead with it. She says they should > definately authorize it (they have before for other patients they > have) and she tells me the date will be the date they sent the > referral to the insurance company. She says they will still cover > even if I start before it is actually authorized. This makes me very > nervous. I plan on paying even if my insurance doesn't but I don't > want to blow it if they will. I have Cigna but it is contracted out > to Hills Physician. It's confusing. > > Thank you, > Tami and Luke > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 9, 2001 Report Share Posted February 9, 2001 Hi Tami The same thing happen to me and my Luke. I was told to wait for authorization before I casted because they said I would get penalized if I started before my insurance company gave me a " yes or no " I waited 2 weeks and finally called VERY angry and said im not waiting any longer I want my son casted regardless and they gave me an answer that day which was " no " off course. THey said it was considered a cosmetic proceedure. We are in the appeal process right now but at least I got the treatment started. Good luck Monday. I would be the same as you and start either way. The waiting time is the worst. HEidi & Luke Phx, Az Quote Link to comment Share on other sites More sharing options...
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