Re: Insurance company not denying band but referring me to others :(

[Guest guest]

Hi Sherry,

Here is a list of questions you should ask:

Does the Orthotist/Clinician have experience treating Positional

Plagiocephaly?

How long have they used the particular band/helmet?

How much does the specific band/helmet cost?

Are all adjustments, castings, appointments, etc, covered in this cost?

Can we be put on a payment plan if our insurance does not cover the cost?

Will the office of the Orthotist/Clinician assist me in appeals

process if my insurance won't cover the cost of the band/helmet?

Is the band/helmet a molding helmet, or does it apply gentle pressure?

Does it have a name brand?

How often will adjustments be made?

What is done to the band/helmet when an adjustment is made?

Will there be a casting?

How long will the casting take, and what should we expect?

How long will it take for the band/helmet to be ready after the casting?

Will we be able to come for the first fitting as soon as the

band/helmet is ready? Or should we make a tentative appointment now?

Will my child's entrance head mold be available for the

Orthotist/Clinician to compare to?

Will measurements be taken periodically to monitor my child's progress?

What would be the approximate length of treatment that my child will

require?

Will more then one band/helmet be required?

What kind of results should we expect?

How long before we see any results?

Will someone be available if we need to come in for an unexpected

adjustment or need to call because there is a problem?

What do we use to clean the band/helmet?

How long and how often, can we remove the band/helmet for cleaning etc.?

Will we be required to do spot checks in the beginning? For how long?

How often? And what are we looking for?

What is the procedure if my child has a temperature?

Will the Orthotist/Clinician be in communication with my child's

doctor over my child's care and treatment?

Who makes the determination of when my child is ready to graduate?

The answers need to come from your potential ortho. :-)

Good luck,

> > > > >

> > > > > My sister is having the exact same problem with her company

> which

> > > is

> > > > > HealthNet of New Jersey/Guardian.

> > > > >

> > > > > First they gave her the name of the places that covered it.

> She

> > > > called them

> > > > > all and they said they no longer worked with HealthNet. So,

> she

> > > > called them and

> > > > > asked about Cranial Tech. They told her they would pay 50%

> since

> > > > they are not

> > > > > a provider.

> > > > >

> > > > > Now they have denied the claim altogether. Saying in wasn't

> > > medically

> > > > > necessary, but they listed two providers in the letter of the

> > > > denial!!! How bizarre

> > > > > is that?

> > > > >

> > > > > This is really a sin! Someone should call 60 minutes or

> something!

> > > > >

> > > >

> > >

> >

>

[Guest guest]

Hi Sherry,

Here is a list of questions you should ask:

Does the Orthotist/Clinician have experience treating Positional

Plagiocephaly?

How long have they used the particular band/helmet?

How much does the specific band/helmet cost?

Are all adjustments, castings, appointments, etc, covered in this cost?

Can we be put on a payment plan if our insurance does not cover the cost?

Will the office of the Orthotist/Clinician assist me in appeals

process if my insurance won't cover the cost of the band/helmet?

Is the band/helmet a molding helmet, or does it apply gentle pressure?

Does it have a name brand?

How often will adjustments be made?

What is done to the band/helmet when an adjustment is made?

Will there be a casting?

How long will the casting take, and what should we expect?

How long will it take for the band/helmet to be ready after the casting?

Will we be able to come for the first fitting as soon as the

band/helmet is ready? Or should we make a tentative appointment now?

Will my child's entrance head mold be available for the

Orthotist/Clinician to compare to?

Will measurements be taken periodically to monitor my child's progress?

What would be the approximate length of treatment that my child will

require?

Will more then one band/helmet be required?

What kind of results should we expect?

How long before we see any results?

Will someone be available if we need to come in for an unexpected

adjustment or need to call because there is a problem?

What do we use to clean the band/helmet?

How long and how often, can we remove the band/helmet for cleaning etc.?

Will we be required to do spot checks in the beginning? For how long?

How often? And what are we looking for?

What is the procedure if my child has a temperature?

Will the Orthotist/Clinician be in communication with my child's

doctor over my child's care and treatment?

Who makes the determination of when my child is ready to graduate?

The answers need to come from your potential ortho. :-)

Good luck,

> > > > >

> > > > > My sister is having the exact same problem with her company

> which

> > > is

> > > > > HealthNet of New Jersey/Guardian.

> > > > >

> > > > > First they gave her the name of the places that covered it.

> She

> > > > called them

> > > > > all and they said they no longer worked with HealthNet. So,

> she

> > > > called them and

> > > > > asked about Cranial Tech. They told her they would pay 50%

> since

> > > > they are not

> > > > > a provider.

> > > > >

> > > > > Now they have denied the claim altogether. Saying in wasn't

> > > medically

> > > > > necessary, but they listed two providers in the letter of the

> > > > denial!!! How bizarre

> > > > > is that?

> > > > >

> > > > > This is really a sin! Someone should call 60 minutes or

> something!

> > > > >

> > > >

> > >

> >

>