Re: Anyone dealt with Humana Insurance? To Jen

[Guest guest]

Hey Jen!! Small world huh? LOL!! We are about 30 miles north of Grand Rapids, we are in a tiny town called Gowen, it's right outside of Greenville. I *think* if I remember right my dad has raced motorcycles in Brighton. We're going to Free Bed in Grand Rapids. Wow the plastic surgeon left it up to your primary? Never heard of that one before LOL!! Our ped left it up to Kaitlyns physical therapist about the helmet and said if she thought Kaitlyn would need one he would go ahead and write the letter to Humana and he did. Yep they approved it on the first try and yep we have the Humana PPO plan!! I can't believe they denied you yet approved us, maybe different types of benefit plans? Or are they all the same? Kaitlyn has the STARlight bi-valve (you can see her pics in the plag photos under Kaitlyn E). Because she has mostly plag yet a touch of scaph we had to go with the bi-valve because it's easier to open up

because her head was so round and stuck out in the back. I tell ya I went thru ALOT to get her in to see the cranial facial specialist with them, it even came down to one day I said I'd had enough, it had been 2 1/2 months of fighting with them when THEY and ME KNEW Dr.Mann was the ONLY specialist around that dealt with this and it came down to me calling a lawyer and asking for advice so they told me to call Humana back up one more time and talk to a manager and let them know you've talked to a lawyer so I did and I gave Humana 1 hour to get the approval or I was calling the lawyer back well within 45 minutes they called and it was approved and it was smooth sailing from there!! But before we saw her orthotist I called Humana one more time to make sure it was covered 100% and it was, we've gotten no bill in the last almost 2 months she's had it. I dealt with one lady and one lady ONLY at Humana because I was sick and tired of dealing with hundreds of reps and

getting different answers, she is a manager there and very nice, her name is Kathy Bratz (I think that is how you spell it), call Humanas 1-800 number that's on your card and ask for extension 7817 that's Kathys extension and ask her for some help, find out why your helmet is getting denied, you can even mention my name if you want, hell she's talked to me 100 times LOL!! I'm sorry that you had to go thru that just because you took your daughter into ER, that's terrible, gosh I can't stand Humana!! I took Kaitlyn in about 2 months ago for RSV and they didn't deny that, gosh do they have something against you? LOL!! If you need ANY help at all in dealing with Humana PLEASE let me know, I've dealt with them for months thru this so I'll help you in any way possible!! Give Kathy a call and let me know how it goes, she should be able to help you out. I hope this helps you!! Hugs, Bobbi :)emsar14 <jengruber@...>

wrote: Hi Bobbi, We are in Michigan also! Where are you? We are just north of Ann Arbor in the Brighton area. We are going to U of M's orthotics and prosthetics department. My ped referred us to UM's plastic surgery department, but they told me that none of the cranio facial surgeons would see us for plagio, that it was up to our primary to diagnose it. So, we went with both the ped and orthotics diagnosis, and went with the helmet. Humana (who I HATE, don't even get me started!), denied it on the pre-auth, saying that it was a "contract exclusion". They wouldn't even tell me why it was excluded. It took my benefits person to get her sales rep to dig and find that out! So I sent them a 40 page appeal, with letters from the doctor about medical necessity.So they

approved it on the first try for you? What kind of helmet do you have? Are you on the Humana PPO plan? The reason I ask is because I thought it was excluded on all of their PPO plans. This could be great ammuntion for me! Humana has been hell for us. They denied an ER visit for when she was 10 days old with 20+ cases of diareah on a Sunday, even though the ped sent us. I had to appeal that, and won, but received a scathing letter from Humana basically telling me that I was irresponsible for taking her to the ER, and that they would be nice this one time. They are just terrible!Good to know someone else hates them!Jen> Hi,> > We are in the process of our appeal with Humana. Thanks for the > wonderful wealth of information and letters in the files, they were > incredibly helpful (in fact, my pediatrician told me she was so > impressed with the letter I wrote. I had to

tell her that I couldn't > take credit for all of it...). Anyway, I'm wondering if anyone out > there has dealt with Humana at all? I feel like I'm getting nowhere > (the denial simply stated "contract exclusion"), but I was able to find > out it is because they deem it cosmetic. > > Did anyone have luck appealing Humana to pay?> > Thanks!> Jen> > Mom to (8.5 months), banded 1/25/06, and Emma (4 years)> > > > > > > For more plagio info

[Guest guest]

Hey Jen!! Small world huh? LOL!! We are about 30 miles north of Grand Rapids, we are in a tiny town called Gowen, it's right outside of Greenville. I *think* if I remember right my dad has raced motorcycles in Brighton. We're going to Free Bed in Grand Rapids. Wow the plastic surgeon left it up to your primary? Never heard of that one before LOL!! Our ped left it up to Kaitlyns physical therapist about the helmet and said if she thought Kaitlyn would need one he would go ahead and write the letter to Humana and he did. Yep they approved it on the first try and yep we have the Humana PPO plan!! I can't believe they denied you yet approved us, maybe different types of benefit plans? Or are they all the same? Kaitlyn has the STARlight bi-valve (you can see her pics in the plag photos under Kaitlyn E). Because she has mostly plag yet a touch of scaph we had to go with the bi-valve because it's easier to open up

because her head was so round and stuck out in the back. I tell ya I went thru ALOT to get her in to see the cranial facial specialist with them, it even came down to one day I said I'd had enough, it had been 2 1/2 months of fighting with them when THEY and ME KNEW Dr.Mann was the ONLY specialist around that dealt with this and it came down to me calling a lawyer and asking for advice so they told me to call Humana back up one more time and talk to a manager and let them know you've talked to a lawyer so I did and I gave Humana 1 hour to get the approval or I was calling the lawyer back well within 45 minutes they called and it was approved and it was smooth sailing from there!! But before we saw her orthotist I called Humana one more time to make sure it was covered 100% and it was, we've gotten no bill in the last almost 2 months she's had it. I dealt with one lady and one lady ONLY at Humana because I was sick and tired of dealing with hundreds of reps and

getting different answers, she is a manager there and very nice, her name is Kathy Bratz (I think that is how you spell it), call Humanas 1-800 number that's on your card and ask for extension 7817 that's Kathys extension and ask her for some help, find out why your helmet is getting denied, you can even mention my name if you want, hell she's talked to me 100 times LOL!! I'm sorry that you had to go thru that just because you took your daughter into ER, that's terrible, gosh I can't stand Humana!! I took Kaitlyn in about 2 months ago for RSV and they didn't deny that, gosh do they have something against you? LOL!! If you need ANY help at all in dealing with Humana PLEASE let me know, I've dealt with them for months thru this so I'll help you in any way possible!! Give Kathy a call and let me know how it goes, she should be able to help you out. I hope this helps you!! Hugs, Bobbi :)emsar14 <jengruber@...>

wrote: Hi Bobbi, We are in Michigan also! Where are you? We are just north of Ann Arbor in the Brighton area. We are going to U of M's orthotics and prosthetics department. My ped referred us to UM's plastic surgery department, but they told me that none of the cranio facial surgeons would see us for plagio, that it was up to our primary to diagnose it. So, we went with both the ped and orthotics diagnosis, and went with the helmet. Humana (who I HATE, don't even get me started!), denied it on the pre-auth, saying that it was a "contract exclusion". They wouldn't even tell me why it was excluded. It took my benefits person to get her sales rep to dig and find that out! So I sent them a 40 page appeal, with letters from the doctor about medical necessity.So they

approved it on the first try for you? What kind of helmet do you have? Are you on the Humana PPO plan? The reason I ask is because I thought it was excluded on all of their PPO plans. This could be great ammuntion for me! Humana has been hell for us. They denied an ER visit for when she was 10 days old with 20+ cases of diareah on a Sunday, even though the ped sent us. I had to appeal that, and won, but received a scathing letter from Humana basically telling me that I was irresponsible for taking her to the ER, and that they would be nice this one time. They are just terrible!Good to know someone else hates them!Jen> Hi,> > We are in the process of our appeal with Humana. Thanks for the > wonderful wealth of information and letters in the files, they were > incredibly helpful (in fact, my pediatrician told me she was so > impressed with the letter I wrote. I had to

tell her that I couldn't > take credit for all of it...). Anyway, I'm wondering if anyone out > there has dealt with Humana at all? I feel like I'm getting nowhere > (the denial simply stated "contract exclusion"), but I was able to find > out it is because they deem it cosmetic. > > Did anyone have luck appealing Humana to pay?> > Thanks!> Jen> > Mom to (8.5 months), banded 1/25/06, and Emma (4 years)> > > > > > > For more plagio info