ahhh... more insurance goof's!!!!

[Guest guest]

I swear, is it only me or does everyone get told something different

each time they speak with insurance??? Last week i posted on how

i've had all these problems with my insurance, etc... Well, for

those that remember what i ranted about, i'm now being told that the

1k we received WAS approval on my appeal which i was orginally told,

and then told not that it was them correcting the fact that they'd

said we'd reached our max on DME for the year which we hadn't. So

now, even after being told friday that my appeal was still in

processing by two different people (one in appeals dept, other in

member sevices), the woman who's been handling my case has told me i

need to submit another appeal to get it covered as in-network.

Which i was starting to do last week after i spoke with her and then

i was told not to because my appeal was still in processing!

AHHH... I'm so frustrated. Also, i've been told by 3 others that

the state (Bureau of Insurance) has also appealed my case. Well,

the woman today said she dosn't see that anywhere. So it's like,

who's right, the woman i've spoken to who knows most about my case,

or 3 random people who wouldn't just make up that the state has an

appeal also... This is so frustrating! I have no idea what i

should write in my appeal aside from, " you have no one in network to

provide coverage " .. What else is there to put??

Thanks for letting me vent!

Ashburn, VA

[Guest guest]

,

UGH!! What a mess. keep fighting! Keep Calling! Don't give up. Write everyone's name down that you speak to, date and time too. they would certainly loose their heads if they were not attached. Is there anyone at the state level you can call to confirm the appeal from them?

As for what to write - there isn't much to it. There is no option - period. They probably won't see it that clearly. You may need to point out that yes there are orthotic company options but they do not treat plagio nor provide moulding bands/helmets.

mom to na

DOC Grad 2/04

SC

www.thefilyaws.com <mamagill@...> wrote:

I swear, is it only me or does everyone get told something different each time they speak with insurance??? Last week i posted on how i've had all these problems with my insurance, etc... Well, for those that remember what i ranted about, i'm now being told that the 1k we received WAS approval on my appeal which i was orginally told, and then told not that it was them correcting the fact that they'd said we'd reached our max on DME for the year which we hadn't. So now, even after being told friday that my appeal was still in processing by two different people (one in appeals dept, other in member sevices), the woman who's been handling my case has told me i need to submit another appeal to get it covered as in-network. Which i was starting to do last week after i spoke with her and then i was told

not to because my appeal was still in processing! AHHH... I'm so frustrated. Also, i've been told by 3 others that the state (Bureau of Insurance) has also appealed my case. Well, the woman today said she dosn't see that anywhere. So it's like, who's right, the woman i've spoken to who knows most about my case, or 3 random people who wouldn't just make up that the state has an appeal also... This is so frustrating! I have no idea what i should write in my appeal aside from, "you have no one in network to provide coverage".. What else is there to put??Thanks for letting me vent!Ashburn, VAFor more plagio info

[Guest guest]

Thanks --

As for fighting for in network coverage, in their provider handbook that

serves 4 states they don't have a cranio doc at all. When i found out CT

was out of network before we even casted i'd asked them for names of

companies who provide a helmet/band but on numerous phone calls to them they

were not able to provide me with any info. All they could do was give me

numbers to different DME companies and I had to call them all to see if they

offered anything for plagio. None did. Their list of DME isn't divided

into what type of equipment each company carries so i had a lot of calling

around to do! Also my ped's were unaware of any other company in our area

that treats plagio (i've since found 2)

>From: Filyaw <monicash@...>

>Reply-Plagiocephaly

>Plagiocephaly

>Subject: Re: ahhh... more insurance goof's!!!!

>Date: Thu, 16 Dec 2004 12:17:56 -0800 (PST)

>

>,

>UGH!! What a mess. keep fighting! Keep Calling! Don't give up. Write

>everyone's name down that you speak to, date and time too. they would

>certainly loose their heads if they were not attached. Is there anyone at

>the state level you can call to confirm the appeal from them?

>

>As for what to write - there isn't much to it. There is no option -

>period. They probably won't see it that clearly. You may need to point

>out that yes there are orthotic company options but they do not treat

>plagio nor provide moulding bands/helmets.

>

>

>mom to na

>DOC Grad 2/04

>SC

>www.thefilyaws.com

>

> <mamagill@...> wrote:

>

>

>I swear, is it only me or does everyone get told something different

>each time they speak with insurance??? Last week i posted on how

>i've had all these problems with my insurance, etc... Well, for

>those that remember what i ranted about, i'm now being told that the

>1k we received WAS approval on my appeal which i was orginally told,

>and then told not that it was them correcting the fact that they'd

>said we'd reached our max on DME for the year which we hadn't. So

>now, even after being told friday that my appeal was still in

>processing by two different people (one in appeals dept, other in

>member sevices), the woman who's been handling my case has told me i

>need to submit another appeal to get it covered as in-network.

>Which i was starting to do last week after i spoke with her and then

>i was told not to because my appeal was still in processing!

>AHHH... I'm so frustrated. Also, i've been told by 3 others that

>the state (Bureau of Insurance) has also appealed my case. Well,

>the woman today said she dosn't see that anywhere. So it's like,

>who's right, the woman i've spoken to who knows most about my case,

>or 3 random people who wouldn't just make up that the state has an

>appeal also... This is so frustrating! I have no idea what i

>should write in my appeal aside from, " you have no one in network to

>provide coverage " .. What else is there to put??

>

>Thanks for letting me vent!

>

>

>Ashburn, VA

>

>

>

>

>

>For more plagio info

[Guest guest]

,

Are you appealing a Cranio dr charge or the CT charge? CT is ortho category so it wouldn't matter about the cranio dr. I'm assuming you got your RX from someone besides a cranio dr.

I would just list all the ones you called or make a statement like what you have written here.

mom to na

DOC Grad 2/04

SC

www.thefilyaws.comlaura gill <mamagill@...> wrote:

Thanks --As for fighting for in network coverage, in their provider handbook that serves 4 states they don't have a cranio doc at all. When i found out CT was out of network before we even casted i'd asked them for names of companies who provide a helmet/band but on numerous phone calls to them they were not able to provide me with any info. All they could do was give me numbers to different DME companies and I had to call them all to see if they offered anything for plagio. None did. Their list of DME isn't divided into what type of equipment each company carries so i had a lot of calling around to do! Also my ped's were unaware of any other company in our area that treats plagio (i've since found 2)>From: Filyaw >Reply-Plagiocephaly >To:

Plagiocephaly >Subject: Re: ahhh... more insurance goof's!!!!>Date: Thu, 16 Dec 2004 12:17:56 -0800 (PST)>>,>UGH!! What a mess. keep fighting! Keep Calling! Don't give up. Write >everyone's name down that you speak to, date and time too. they would >certainly loose their heads if they were not attached. Is there anyone at >the state level you can call to confirm the appeal from them?>>As for what to write - there isn't much to it. There is no option - >period. They probably won't see it that clearly. You may need to point >out that yes there are orthotic company options but they do not treat >plagio nor provide moulding bands/helmets.>>>mom to na>DOC Grad 2/04>SC>www.thefilyaws.com>> wrote:>>>I swear, is it only me or does everyone get told something

different>each time they speak with insurance??? Last week i posted on how>i've had all these problems with my insurance, etc... Well, for>those that remember what i ranted about, i'm now being told that the>1k we received WAS approval on my appeal which i was orginally told,>and then told not that it was them correcting the fact that they'd>said we'd reached our max on DME for the year which we hadn't. So>now, even after being told friday that my appeal was still in>processing by two different people (one in appeals dept, other in>member sevices), the woman who's been handling my case has told me i>need to submit another appeal to get it covered as in-network.>Which i was starting to do last week after i spoke with her and then>i was told not to because my appeal was still in processing!>AHHH... I'm so frustrated. Also, i've been told by 3 others that>the state (Bureau of Insurance)

has also appealed my case. Well,>the woman today said she dosn't see that anywhere. So it's like,>who's right, the woman i've spoken to who knows most about my case,>or 3 random people who wouldn't just make up that the state has an>appeal also... This is so frustrating! I have no idea what i>should write in my appeal aside from, "you have no one in network to>provide coverage".. What else is there to put??>>Thanks for letting me vent!>>>Ashburn, VA>>>>>>For more plagio info