Guest guest Posted July 29, 2004 Report Share Posted July 29, 2004 We just received our first denial from Federal BCBS for my son's DOC band. Does anyone have experience with appealing Federal BCBS? The denial reads " we do not provide benefits for services and supplies not specifically listed as covered in your benefit plan brochure. " I was hoping for a medical necessity denial or something similar. I am afraid this denial will be harder to fight. Any help will be greatly appreciated. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 29, 2004 Report Share Posted July 29, 2004 Hi there I would start by going through your benefit plan, and see what you can use to appeal. CT has packages to help with the appeals, and there is tons of info in our database and file section. Good luck and keep us updated on how it goes Sandy --- In Plagiocephaly , " " <amandamurrell@y...> wrote: > We just received our first denial from Federal BCBS for my son's DOC > band. Does anyone have experience with appealing Federal BCBS? The > denial reads " we do not provide benefits for services and supplies > not specifically listed as covered in your benefit plan brochure. " I > was hoping for a medical necessity denial or something similar. I am > afraid this denial will be harder to fight. Any help will be greatly > appreciated. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 29, 2004 Report Share Posted July 29, 2004 It sounds like you have wiggle room. If the helmet isn't specifically EXCLUDED you might be able to appeal. You'll have to go through the policy page by page to see if you can find a loophole. The brochure they mention hopefully has vague language. If insurance language is ambiguous and you appeal or take them to court, the court will rule in your favor. If you want to send me a copy I would be happy to read it and try to help find a hole. , 20 mos --- In Plagiocephaly , " " <amandamurrell@y...> wrote: > We just received our first denial from Federal BCBS for my son's DOC > band. Does anyone have experience with appealing Federal BCBS? The > denial reads " we do not provide benefits for services and supplies > not specifically listed as covered in your benefit plan brochure. " I > was hoping for a medical necessity denial or something similar. I am > afraid this denial will be harder to fight. Any help will be greatly > appreciated. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 29, 2004 Report Share Posted July 29, 2004 Hi, Was your script for a DOCband? If so, you can always tell them that they don't have anyone in network. They can't have Cranial Tech listed in there book. Do you know what I'm trying to say, for some reason I don't think I'm getting across what I'm trying to say. --- In Plagiocephaly , " " <amandamurrell@y...> wrote: > We just received our first denial from Federal BCBS for my son's DOC > band. Does anyone have experience with appealing Federal BCBS? The > denial reads " we do not provide benefits for services and supplies > not specifically listed as covered in your benefit plan brochure. " I > was hoping for a medical necessity denial or something similar. I am > afraid this denial will be harder to fight. Any help will be greatly > appreciated. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 30, 2004 Report Share Posted July 30, 2004 , I'm not very insurance savvy, but it sounds like an exclusion denial??? As said, we have some sample appeals in the files/insurance folder that address this type of denial. Also, you could check in the links/insurance section of the group for some additional ideas - I believe the CAPPSkids website has an example for tackling an exclusion appeal as well. Will you let us know if these tips help? Good luck, Christie (Mom to Repo'd Remy) --- In Plagiocephaly , " " <amandamurrell@y...> wrote: > We just received our first denial from Federal BCBS for my son's DOC > band. Does anyone have experience with appealing Federal BCBS? The > denial reads " we do not provide benefits for services and supplies > not specifically listed as covered in your benefit plan brochure. " I > was hoping for a medical necessity denial or something similar. I am > afraid this denial will be harder to fight. Any help will be greatly > appreciated. Quote Link to comment Share on other sites More sharing options...
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