- medical necessity

[Guest guest]

Hi everyone,

I decided to get my insurance ducks in a row, after hearing the

insurance stories. So I called our company this morning. After 2

dead calls, I finally reached a human, who said we are covered up to

$3,000 with a letter of medical necessity. Now, since the

neurosurgeon said it isn't necessary to band , how should I get

that letter? Should I ask our pediatricians to write it and the RX

(they probably would) or go back to the neuro? The nurse

practicioner did say that most of the babies they saw who had been

banded were because the parents insisted. So it sounds like if I

push them, they would write the RX and letter. But it would be

easier to get the ped to do it. But would the insurance company deny

if they ped says it's necessary while the neuro says it isn't?

And the insurance rep told me to call a company called Homelink,

which coordinates DME for them. So I talked to a very nice couple of

people there, who started a file on , and didn't know much about

banding. But they are simply the coordinators between the insurance

company and the orthotist. If I go directly to someone without going

through Homelink, my out-of-network benefits apply, which means a

deductible and co-insurance payment. Homelink then called their

network orthotist closest to us, to ask if they do banding. Then the

orthotist company called me, they have a file set up on too,

received pre-authorization from Homelink, and were ready to schedule

an appointment! Yikes - too fast! LOL I don't have the RX yet,

haven't even decided to do this yet! LOL

And I scheduled an appt for with CT in Paramus on Tuesday the

10th, to see what they think about her face and head. So I won't be

making any decisions until then. And I need to find out how

experienced this local orthotist is with the band. The woman I

talked to didn't know specifically. It's a family chain, father and

several sons, been in business for decades. It's very convenient -

they have two offices within 30 minutes of us and see patients twice

a week at the hospital 10 minutes away. But - that doesn't mean

anything if they don't know what they're doing with bands! Plus,

Homelink says they are willing to work with any orthotist who is

willing to work with them, so I might be able to get network benefits

if I go with CT or another orthotist.

I can't believe how easy it was! Now the decision, the hard part. I

was scrutinizing 's face last night, trying to picture her in a

couple of years with the same asymmetry, and DH said " Just band her

already and stop torturing us all! " He was half joking, but I think

the underlying point is right. If my instinct is to band her, then

we should do it.

Best wishes,

mom to , 10, HLHS heart transplant, , 9, Abigial,

2 1/2, BAV and PFO, and , 9 months tomorrow, mild plagio.