Re: To wait or not to wait

[Guest guest]

Mei-

I would make your appointment with CT while the ball is rolling. We

had an appointment on on Wednesday for the initial consult. They

helped with the insurance papers which I mailed Thursday. I got the

denial the following Wed and he was casted that Saturday. It can

take a while to get appointments, so just go ahead and make the appt

and then if you need to reschedule do it> I'm sure someone would

love to be bumped up to an earlier spot!

Our insurance company required that we be denied before the

casting. Otherwise I think we may have forfeited our right to an

appeal. Lucky for us they were fast in denying us. But, they never

did end up paying!

Record the name and date of everyone you speak with at the insurance

company.

We did things so methodically that we didn't loose anytime by

waiting to hear from them.

Is your son in PT for torticollis (tight neck muscle)?

Dane's mom DOC Grad

[Guest guest]

I don't know myself but Capps has a great page covering this stuff.

Check it out. http://www.cappskids.org/PlagioInsuranceHelp.htm

Good Luck,

Heidi - 9 months (tort/plagio)

> Thanks for those who answered my first post on STAR or DOC Band.

I'm

> still new here so would like to tell my stories so far.

>

> My son was born in April last year and is 9 1/2 months. From month

1

> he'd like to tilt to the right side to sleep. I read somewhere

that

> this will not cause plagio, so even though my mother-in-law wanted

to

> put towel under his chin to reposition, I assured her that it was

not

> necessary. The ped. also said it'd round out in time, and didn't

> mention any intervention option apart from repositioning. I

trusted

> it may improve on its own but was also prepared to have him as a

flat-

> headed boy for life. Then at 9 months check-up the ped. sent us to

> the specialist; he said he thought about referring us a month

earlier

> but forgot. Only then did I start to read about plagio and got

very

> concerned that time has been wasted.

>

> We went to the specialist at Craniofacial Clinic at ST. 's U.

> Hospital in NJ yesterday. They say the baby is a classic case of

> plagio, and rated the condition as moderate. His soft spot is

found

> to be still there. And DOC band was prescribed.

>

> I have BC/BS of NJ as insurance carrier. Just called and found out

> that they need pre-authorization. I've given the specialist's

phone

> number to CT and they are going to call insurance to send out

> information. I'm right now debating with myself as for whether to

> wait. Is it true that it is most likely to be denied anyway? If

so

> waiting would be pointless - I hope the baby got the band around

his

> 10th month and not later. But it is a lot of money to pay out of

> pocket, even though we have the money in the bank. So if we go

ahead

> and get the treatment while the aplication for pre-authorization is

> being processed, they can deny us even if they pre-approve it later?

>

> I'll let you know what I do next. Any tips and advice at this

point

> is appreciated.

>

> Mei, NJ

[Guest guest]

Mei:

I've heard of insurance companies denying the claim simply because of

NOT going thru the proper process so you might want to wait to see

what your insurance company says. But I can certainly understand

your urgency.

Hopefully you'll get a response very soon from BCBS, and of course,

hopefully it'll be an approval.

Keep us posted. I'm glad you had a good appt with your specialist,

always nice to hear. Good luck.

Debbie Abby's mom DOCGrad

MI

> Thanks for those who answered my first post on STAR or DOC Band.

I'm

> still new here so would like to tell my stories so far.

>

> My son was born in April last year and is 9 1/2 months. From month

1

> he'd like to tilt to the right side to sleep. I read somewhere

that

> this will not cause plagio, so even though my mother-in-law wanted

to

> put towel under his chin to reposition, I assured her that it was

not

> necessary. The ped. also said it'd round out in time, and didn't

> mention any intervention option apart from repositioning. I

trusted

> it may improve on its own but was also prepared to have him as a

flat-

> headed boy for life. Then at 9 months check-up the ped. sent us to

> the specialist; he said he thought about referring us a month

earlier

> but forgot. Only then did I start to read about plagio and got

very

> concerned that time has been wasted.

>

> We went to the specialist at Craniofacial Clinic at ST. 's U.

> Hospital in NJ yesterday. They say the baby is a classic case of

> plagio, and rated the condition as moderate. His soft spot is

found

> to be still there. And DOC band was prescribed.

>

> I have BC/BS of NJ as insurance carrier. Just called and found out

> that they need pre-authorization. I've given the specialist's

phone

> number to CT and they are going to call insurance to send out

> information. I'm right now debating with myself as for whether to

> wait. Is it true that it is most likely to be denied anyway? If

so

> waiting would be pointless - I hope the baby got the band around

his

> 10th month and not later. But it is a lot of money to pay out of

> pocket, even though we have the money in the bank. So if we go

ahead

> and get the treatment while the aplication for pre-authorization is

> being processed, they can deny us even if they pre-approve it later?

>

> I'll let you know what I do next. Any tips and advice at this

point

> is appreciated.

>

> Mei, NJ

[Guest guest]

I personally would not wait. CT does have a payment plan, so if you

can swing it then I would go for it. I did this but have since been

reimbursed by like 70% and am writing an appeal. You still have to

be casted and the band made. That is like 2-3 wks I think. Kady was

casted at 5 3/4 and in by 6 1/4. She was also born in April. Your

decision should also be based on whether or not you would band if you

knew your insurance would not pay.

[Guest guest]

Shari,

Spot on. I have Ushers as well and would very much like to go bilateral

but with Medicare, its not possible. Otherwise I would not hesitate

regardless of the promise of current research.

Quote of the nanosecond. . .

A word to the wise ain't necessary - it's the stupid ones that need the

advice.

--Bill Cosby

& Dreamer Doll ke7nwn

E-mail-

rclark0276@...

Home Page-

http://webpages.charter.net/dog_guide/

To Wait or Not to Wait

Hi List,

Thought this was an interesting topic.

While I understand why some want to wait for whatever the science

researchers can do to restore hearing besides the CI (i.e. gene therapy or

something else) and just waiting for the next best technology for CIs.

I think about gene thereapy and how if they could isolate each Usher

syndrome gene and restore some of the heearing AND sight, what about now? At

least there's a CI for hearing now. Yes, I may have to wait until my

processor becomes obsolete in order to get the latest upgrade. But they are

still good. I wouldn't buy a new car every year because there's a newer

model with better features. It still works. Of course, I don't drive

anymore, but I'm just saying we wpi;d still have a good working CI if we

kept it in good running condition. I know I won't be able to afford getting

an upgrade every four or five years when a new model comes out..

I also want to say that for me, declining vision makes me want to HEAR and

hear now. I honestly don't know where I would be right now if it weren't for

the vision issue. Would I still have gone for a CI? Maybe. I haven't faced

total deafness in both ears, just one, The second ear still had some

residual hearing, so I will not be able to answer that question. Some people

had lost hearing in one ear and until the second ear didn't pick up speech

anymore, they were devesated and were very happy to get CIs.

But I do know that I am not sorry I got a CI. And while I'm recovering from

the second implant, I know that I'll be happy to HEAR with both EARS. .I

look forward to sharing my activation with you all next month.

Shari in WI

[Guest guest]

Hi Shire, I'm new to this forum(2moths) and I with the others will be with

you in our commen loss of heaeing comp Wayne,

[Guest guest]

Hear, hear, .

 

(in more ways than one.)

 

Just have to add that i enjoy the amusing or thought-provoking quotes.

 

Shari

[Guest guest]

I've been absent from the forum for quite a while. I was implanted in 2006 and

am doing wonderfully. My question. I am considering a second implant my

" better ear " which now also has no usable hearing. I was under the impression

that Medicare would pay for a second implant (the first was with private

insurance). Is that incorrect?

>

> Shari,

> Spot on. I have Ushers as well and would very much like to go bilateral

> but with Medicare, its not possible. Otherwise I would not hesitate

> regardless of the promise of current research.

>

> Quote of the nanosecond. . .

> A word to the wise ain't necessary - it's the stupid ones that need the

> advice.

> --Bill Cosby

> & Dreamer Doll ke7nwn

> E-mail-

> rclark0276@...

> Home Page-

> http://webpages.charter.net/dog_guide/

>

[Guest guest]

Shari,

Check with your hospital. But the general rule is that Medicare will

pay for ONE, so if private insurance paid for the other, it should be a

go.

so GO for it.

I've been absent from the forum for quite a while. I was implanted in

2006 and am doing wonderfully. My question. I am considering a second

implant my " better ear " which now also has no usable hearing. I was under

the impression that Medicare would pay for a second implant (the first

was with private insurance). Is that incorrect?

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