Re: Insurance Appeal Update

[Guest guest]

I hope you can get somewhere with your appeal, . Keep us

posted, Natasha

--- In Plagiocephaly , " Filyaw " <filyaw@b...>

wrote:

> There may be light at the end of the tunnel. We had a contract

exclusion. It was denied. It went to my corporate HR. I was

emailing my contact person today and got some good news (at least

better than any I have received to date).

>

> It appears that the exclusion is not supposed to be there.

>

> Here is what she said ...

> " I too found that exclusion clause, but it is not an exclusion with

our other carriers as long as it is medically necessary, therefore, I

assume too that it is an old document that needs to be updated. I

have provided Companion with our other carriers " book of business "

regarding coverage based on medical necessity and hope to hear back

from them this week. "

>

> So, yes, I wanted to start jumping for joy. However, it now goes

to whatever Companion Healthcare (BCBS SC) usually covers. They are

notorious for no coverage. I guess the best case scenario would be

10% copay. Worst case still no coverage because they feel it doesn't

meet their guidelines.

>

> So, moral of this long post. If you have contract exclusion make

sure they are working from a recent and correct contract.

>

> & na

[Guest guest]

WOW !! Great investigating work!!! I never would have thought

about that one. Let us know how you pan out now!

Dustie

--- In Plagiocephaly , " Filyaw " <filyaw@b...>

wrote:

> There may be light at the end of the tunnel. We had a contract

exclusion. It was denied. It went to my corporate HR. I was

emailing my contact person today and got some good news (at least

better than any I have received to date).

>

> It appears that the exclusion is not supposed to be there.

>

> Here is what she said ...

> " I too found that exclusion clause, but it is not an exclusion with

our other carriers as long as it is medically necessary, therefore, I

assume too that it is an old document that needs to be updated. I

have provided Companion with our other carriers " book of business "

regarding coverage based on medical necessity and hope to hear back

from them this week. "

>

> So, yes, I wanted to start jumping for joy. However, it now goes

to whatever Companion Healthcare (BCBS SC) usually covers. They are

notorious for no coverage. I guess the best case scenario would be

10% copay. Worst case still no coverage because they feel it doesn't

meet their guidelines.

>

> So, moral of this long post. If you have contract exclusion make

sure they are working from a recent and correct contract.

>

> & na

[Guest guest]

Hi :

Sounds like a glimmer of hope for you!! I hope they'll approve it.

Fingers are crossed, keep us posted.

Debbie

--- In Plagiocephaly , " Filyaw " <filyaw@b...>

wrote:

> There may be light at the end of the tunnel. We had a contract

exclusion. It was denied. It went to my corporate HR. I was

emailing my contact person today and got some good news (at least

better than any I have received to date).

>

> It appears that the exclusion is not supposed to be there.

>

> Here is what she said ...

> " I too found that exclusion clause, but it is not an exclusion with

our other carriers as long as it is medically necessary, therefore, I

assume too that it is an old document that needs to be updated. I

have provided Companion with our other carriers " book of business "

regarding coverage based on medical necessity and hope to hear back

from them this week. "

>

> So, yes, I wanted to start jumping for joy. However, it now goes

to whatever Companion Healthcare (BCBS SC) usually covers. They are

notorious for no coverage. I guess the best case scenario would be

10% copay. Worst case still no coverage because they feel it doesn't

meet their guidelines.

>

> So, moral of this long post. If you have contract exclusion make

sure they are working from a recent and correct contract.

>

> & na