- one more question about BCBS

[Guest guest]

Hi ,

Just wondering if BCBS paid for Hannah's bands from the beginning or

only after you appealed? Was is state or federal, PPO, HMO or neither?

If you did appeal, did you do it right away, or was it after you found

out she needed a second band? Did they pay for all three? What was

their reason for initial denial? Our letter said that band treatment

was " not medically necessary " and our case " does not meet their

criteria " . I do know that tort. wasn't diagnosed the first time - and

that may have influenced their decision. I found out they did cover

band treatment (after an appeal) for another baby - whose measurements

were lower than Meredith's.

Thanks,

from SC

> > Hey there!

> > Well, we finally received our denial letter from BCBS TX.

> > Geesh...took them long enough! I have already started our appeal

> > letter. Thanks to all the information in the files and links

> section

> > plus the CT appeal packet, I hope to make a pretty good case.

They

> > denied it because they view the treatment as

> > investigational/experimental. I called them to get a further

> > explaination. It appears that they would cover it if he had

> surgery,

> > but view it as cosmetic since he did not. Give me a break!!

> >

> > Well, I will give a quick update on . He has been doing

> great

> > in his DOC band. We have already seen quite a bit of progress. He

> has

> > had 2 adjustments already and at both quite a bit was shaved off

> to

> > allow for more growth. Our next appt is next Monday. This has

been

> > such a positive experience, (well, other than the insurance issue)

> > I am so glad we did it! I added a couple of pics to 's

> folder

> > last week. It is under Matt C.

> >

> > Thanks for all of your support---This board has been such a

> blessing

> > to me. I have learned so much from what I have read here.

> >

> > Jill and (7 mos, DOC 5/20)

> > Dallas