Blue Cross/FEP insurance update

[Guest guest]

Hi all.

Just wanted to let you know that Blue Cross's Federal Employee Program

covered $1,222.00 of the $3,000.00 DOC Band for Liliana. I called

yesterday to find out, and the customer service agent provided me with

the figures, but I haven't received the letter of explanation yet. We

will fight to get more coverage. According to my understanding it

should have been covered at 80% but I admit I'm not sure where we

stand on meeting our family deductible for the year.

At least the folks at Cranial Tech in ndale, VA have all the

paperwork lined up to help with the battle. Maybe this is one

situation where being a severe case can help?

~

Liliana 12 months DOC Band since 9/2/05

Columbia, MD

[Guest guest]

Hi all.

Just wanted to let you know that Blue Cross's Federal Employee Program

covered $1,222.00 of the $3,000.00 DOC Band for Liliana. I called

yesterday to find out, and the customer service agent provided me with

the figures, but I haven't received the letter of explanation yet. We

will fight to get more coverage. According to my understanding it

should have been covered at 80% but I admit I'm not sure where we

stand on meeting our family deductible for the year.

At least the folks at Cranial Tech in ndale, VA have all the

paperwork lined up to help with the battle. Maybe this is one

situation where being a severe case can help?

~

Liliana 12 months DOC Band since 9/2/05

Columbia, MD

[Guest guest]

,

That great that they will at least pay part of it. Let us know how

things go at CT.

CAROLG

> Hi all.

>

> Just wanted to let you know that Blue Cross's Federal Employee Program

> covered $1,222.00 of the $3,000.00 DOC Band for Liliana. I called

> yesterday to find out, and the customer service agent provided me with

> the figures, but I haven't received the letter of explanation yet. We

> will fight to get more coverage. According to my understanding it

> should have been covered at 80% but I admit I'm not sure where we

> stand on meeting our family deductible for the year.

>

> At least the folks at Cranial Tech in ndale, VA have all the

> paperwork lined up to help with the battle. Maybe this is one

> situation where being a severe case can help?

>

> ~

> Liliana 12 months DOC Band since 9/2/05

> Columbia, MD

[Guest guest]

,

That great that they will at least pay part of it. Let us know how

things go at CT.

CAROLG

> Hi all.

>

> Just wanted to let you know that Blue Cross's Federal Employee Program

> covered $1,222.00 of the $3,000.00 DOC Band for Liliana. I called

> yesterday to find out, and the customer service agent provided me with

> the figures, but I haven't received the letter of explanation yet. We

> will fight to get more coverage. According to my understanding it

> should have been covered at 80% but I admit I'm not sure where we

> stand on meeting our family deductible for the year.

>

> At least the folks at Cranial Tech in ndale, VA have all the

> paperwork lined up to help with the battle. Maybe this is one

> situation where being a severe case can help?

>

> ~

> Liliana 12 months DOC Band since 9/2/05

> Columbia, MD

[Guest guest]

,

I am with Federal BCBS too (and using CT in ndale). I just found

out today that BCBS allows $1800 for this procedure, and after meeting

our deductible, they are sending us $1,264.00. I am also going to

appeal, based on the fact that there are a number of BCBS patients in

the database that recieved full (or much better) coverage. At the risk

of running too long, I'll try to post them below. These are all the

BCBS in the database (Note the first three are Federal BCBS!):

Name State / Country Insurance provider Percentage paid (by provider) /

How many appeals before coverage? / Was baby born w/flat spot? /

Torticollis present? / " helmet " type?(DOCband, STARband...)

and Greenup Kansas Blue Cross Federal Program PPO All but

$159 of $3,500 one

T. Oklahoma BCBS Oklahoma Federal Employee 90% ($990 of $1100) 0

yes yes STARband

Polly & VA Federal Employees Blue Cross 90% 0 no yes

STARband

Amy and Les Mennenga North Carolina BCBS of North Carolina $600

starting first no yes none yet

Amy and Les Mennenga North Carolina BCBS of North Carolina $600 $600

from the start. Denied further coverage after 1st appeal no yes DOC

band. 6 weeks in, so much improvement!!!

Gagen Missouri BCBS of MO - Alliance Choice PPO 80% (but since

they were in-network, the amount we paid was less than 20%) 0 not sure

yes PPO helmet

Harvel Georgia BCBS of GA 0 Waiting result from appeal number 1

No No DOC Band

& Virginia Federal Employees BC/BS in process No yes

in process

Bekinda Ivetich Indiana Blue Cross/Blue Shield of Illinois-HMO 100% 0

no yes Ballert Ortho

Beth Freshwater Florida BC/BS of Florida 0 1st one under way no yes doc

e Meisner Michigan Blue Cross/Blue Shield 90% None No No Locally

Charlotte Florida Blue Cross Blue Shield 0% currently in appeal

adopted at 13 months no DOCba

and Trevor North Carolina/USA Blue Cross Blue Shield of

NC (MedPoint) 100% of first band (?? of second band) 1 for first band

No Yes DOC

Massett New York Blue Shield of Northeastern NY waiting 2 NO NO

DOC Band

Cory Schwemley Oklahoma/USA Anthem BC/BS of Virginia 80% One and it was

done completely over the phone, no paperwork was sent in. They wanted

to pay as out of network so I appealed based on the fact that there are

no other providers in my state. no yes STARband

Cristina Cordoba California, USA Blue Cross 90% 0 Don't think so No DOC

Emilie Joost Rhode Island BCBS-Healthmate not sure yet no yes STARband

Indiana Anthem BC/BS 0 3 internal, 1 external, filing

lawsuit yes no DOC

Weldon Tennessee BCBS 100% after a $250.00 deductible 1 No,

developed it...Positional Plagio No Designed By

J. Tolbert Arizona/USA Capital Blue Cross of Pennsylvania 100% 3

internal and 1 external (1 1/2 years) no yes DOC band

Jane Bennorth New Jersey BCBSNJ - Horizon 0 4 yes yes DOC Band

Janna Missouri, St. Louis BCBS of MO 80% 0 no no Local Helmet PP & O St.

Louis

Jimmie Barrett Virginia CareFirst Blue Cross Blue Shield 90% 1 yes mild

DOCband

(Milan) Tomaska Minnesota BCBS of MN 80% 0 yes no CranioCap

Dishman Texas Wellmark BCBS 0 working on 1st yes no STARband

Dishman Texas Wellmark BCBS 67% 0-they initially denied coverage,

but after I filed claim, they pd Yes No STARband

Kim Myers IL - Chicago BCBS IL, PPO 0 so far we're on the 3rd/4th not

noted in his records (which is causing the problem) but yes - from

vaccuum. Yes DOC

Kim Myers IL BCBS of IL PPO 0 No Coverage - Exhausted Appeals, joining

lawsuit Yes Yes DOC

Kris Weatherford NC / USA CareFirst BCBS of MD 0% 1st appeal in

process / 2nd appeal on its way to them No Yes DOC band

Gill () VA BCBS- Capital Care, Inc. (HMO) 33% covered $1k

as out of network, working on getting covered as in-network 1 not sure

mild DOC Band

Laurie Becker (Tommy's mom) MA/ USA BCBS 80% ($1600 of $2000) none no

yes Hanger

& Rich Gudmunsen Minnesota BCBS 100% (Physical Therapy 80%) 0 No

Yes CranioCap (Gillette Children's, St. , MN)

Lori H. New Albany, IN Anthem BCBS of KY 80%-in network level none born

with plagio due to IUGR/torticollis Yes DOCBand

Matt and a Walberg Kansas BC/BS of Kansas City 0 0 No No STARBand

CT BCBS - Bluecare 100% 0 No Yes Docband

& Parent Hollywood, FL BCBS PPO 100 % 1, with the help

insurance attorney no yes DOC

& Parent Hollywood, FL Blue Cross Blue Shield PPO

none yet starting 1st appeal for DOC Band no yes STARband

Drake Columbus Ga USA Blue Cross Blue Shield SC PPO 100% MINUS

$40.00 COPAY 0 YES YES STARband

Filyaw SC/USA Companion Healthcare (BC/BS) 100% DME with $20

copay 1, company is self insured yes yes 2 DOC Bands (1st is paid for

awaiting news on 2nd)

& Tim Manson Minneapois, MN Blue Cross/Blue Sheild of MN %100 0

No Yes CranioCap

Natasha Gubash Georgia BCBS of AL PPO 90% none no yes DOCband

Florida BCBS Health Options None yet In the process of the 3rd

appeal No No STARband

Niki J. PA BCBS Personal Choice 100% 0 no no STARband

Christopoulos IL BC/BS IL PPO 0 Currently working on first Yes

Yes DOCband

R Forester IL BCBS IL, PPO 0 Currently working on 2nd No Yes DOC

Rhiannon and Marshall Texas, USA BCBS-Texas none yet none yet

vaccum assisted birth yes DOC band

Sara () Snyder Indiana BCBS of IL (PPO) 80% 0 yes yes Starband

Bertling Ma BCBS of MA (HMO & treatment was in Connecticut) 100%

of 2 bands 1 Yes No 2 DOCbands

Sasha Harkins IN Anthem BCBS 80 0 yes yes local helmet - we had to get

pre-approved before getting helmet. they say they'll pay 80%

Dennis NJ Horizon Blue Cross/Blue Shield approx. 67% (after

deductible) 1 Yes Yes DOC

Sohnia Hong TN BCBS PPO (State Employees) 0% so far Currently working

on first No No Local

Sue Ellen NY, USA Blue Cross/Blue Shield 100%! -0-!!!! No No STARband

& JD Lanham Texas/USA Anthem BCBS 80% 0 no yes DOCband

T Boyett Texas BCBS of Texas Health Select (self-funded) 0 2 appeals

then filed grievence through ERS (Employees Retirement System) no yes

DOC Band

TBoyett Texas BCBS Texas Health Select 0 1- working on 2nd no yes DOC

Band

Vicki Meagher IL BlueCross BlueShield of IL 0% Currently working on

first appeal No No DOC Band

Derrick CA/USA Blue Shield PPO about 40% 0 No No DOC

Yi-Fan Fu pa HealthOne of Blue Cross/Blue Shield none yet one appeal so

far starband

andrew mi bcbs all but 10% 0 not to our knowledge no danmar

Amy O'D

> Hi all.

>

> Just wanted to let you know that Blue Cross's Federal Employee Program

> covered $1,222.00 of the $3,000.00 DOC Band for Liliana. I called

> yesterday to find out, and the customer service agent provided me with

> the figures, but I haven't received the letter of explanation yet. We

> will fight to get more coverage. According to my understanding it

> should have been covered at 80% but I admit I'm not sure where we

> stand on meeting our family deductible for the year.

>

> At least the folks at Cranial Tech in ndale, VA have all the

> paperwork lined up to help with the battle. Maybe this is one

> situation where being a severe case can help?

>

> ~

> Liliana 12 months DOC Band since 9/2/05

> Columbia, MD

[Guest guest]

,

I am with Federal BCBS too (and using CT in ndale). I just found

out today that BCBS allows $1800 for this procedure, and after meeting

our deductible, they are sending us $1,264.00. I am also going to

appeal, based on the fact that there are a number of BCBS patients in

the database that recieved full (or much better) coverage. At the risk

of running too long, I'll try to post them below. These are all the

BCBS in the database (Note the first three are Federal BCBS!):

Name State / Country Insurance provider Percentage paid (by provider) /

How many appeals before coverage? / Was baby born w/flat spot? /

Torticollis present? / " helmet " type?(DOCband, STARband...)

and Greenup Kansas Blue Cross Federal Program PPO All but

$159 of $3,500 one

T. Oklahoma BCBS Oklahoma Federal Employee 90% ($990 of $1100) 0

yes yes STARband

Polly & VA Federal Employees Blue Cross 90% 0 no yes

STARband

Amy and Les Mennenga North Carolina BCBS of North Carolina $600

starting first no yes none yet

Amy and Les Mennenga North Carolina BCBS of North Carolina $600 $600

from the start. Denied further coverage after 1st appeal no yes DOC

band. 6 weeks in, so much improvement!!!

Gagen Missouri BCBS of MO - Alliance Choice PPO 80% (but since

they were in-network, the amount we paid was less than 20%) 0 not sure

yes PPO helmet

Harvel Georgia BCBS of GA 0 Waiting result from appeal number 1

No No DOC Band

& Virginia Federal Employees BC/BS in process No yes

in process

Bekinda Ivetich Indiana Blue Cross/Blue Shield of Illinois-HMO 100% 0

no yes Ballert Ortho

Beth Freshwater Florida BC/BS of Florida 0 1st one under way no yes doc

e Meisner Michigan Blue Cross/Blue Shield 90% None No No Locally

Charlotte Florida Blue Cross Blue Shield 0% currently in appeal

adopted at 13 months no DOCba

and Trevor North Carolina/USA Blue Cross Blue Shield of

NC (MedPoint) 100% of first band (?? of second band) 1 for first band

No Yes DOC

Massett New York Blue Shield of Northeastern NY waiting 2 NO NO

DOC Band

Cory Schwemley Oklahoma/USA Anthem BC/BS of Virginia 80% One and it was

done completely over the phone, no paperwork was sent in. They wanted

to pay as out of network so I appealed based on the fact that there are

no other providers in my state. no yes STARband

Cristina Cordoba California, USA Blue Cross 90% 0 Don't think so No DOC

Emilie Joost Rhode Island BCBS-Healthmate not sure yet no yes STARband

Indiana Anthem BC/BS 0 3 internal, 1 external, filing

lawsuit yes no DOC

Weldon Tennessee BCBS 100% after a $250.00 deductible 1 No,

developed it...Positional Plagio No Designed By

J. Tolbert Arizona/USA Capital Blue Cross of Pennsylvania 100% 3

internal and 1 external (1 1/2 years) no yes DOC band

Jane Bennorth New Jersey BCBSNJ - Horizon 0 4 yes yes DOC Band

Janna Missouri, St. Louis BCBS of MO 80% 0 no no Local Helmet PP & O St.

Louis

Jimmie Barrett Virginia CareFirst Blue Cross Blue Shield 90% 1 yes mild

DOCband

(Milan) Tomaska Minnesota BCBS of MN 80% 0 yes no CranioCap

Dishman Texas Wellmark BCBS 0 working on 1st yes no STARband

Dishman Texas Wellmark BCBS 67% 0-they initially denied coverage,

but after I filed claim, they pd Yes No STARband

Kim Myers IL - Chicago BCBS IL, PPO 0 so far we're on the 3rd/4th not

noted in his records (which is causing the problem) but yes - from

vaccuum. Yes DOC

Kim Myers IL BCBS of IL PPO 0 No Coverage - Exhausted Appeals, joining

lawsuit Yes Yes DOC

Kris Weatherford NC / USA CareFirst BCBS of MD 0% 1st appeal in

process / 2nd appeal on its way to them No Yes DOC band

Gill () VA BCBS- Capital Care, Inc. (HMO) 33% covered $1k

as out of network, working on getting covered as in-network 1 not sure

mild DOC Band

Laurie Becker (Tommy's mom) MA/ USA BCBS 80% ($1600 of $2000) none no

yes Hanger

& Rich Gudmunsen Minnesota BCBS 100% (Physical Therapy 80%) 0 No

Yes CranioCap (Gillette Children's, St. , MN)

Lori H. New Albany, IN Anthem BCBS of KY 80%-in network level none born

with plagio due to IUGR/torticollis Yes DOCBand

Matt and a Walberg Kansas BC/BS of Kansas City 0 0 No No STARBand

CT BCBS - Bluecare 100% 0 No Yes Docband

& Parent Hollywood, FL BCBS PPO 100 % 1, with the help

insurance attorney no yes DOC

& Parent Hollywood, FL Blue Cross Blue Shield PPO

none yet starting 1st appeal for DOC Band no yes STARband

Drake Columbus Ga USA Blue Cross Blue Shield SC PPO 100% MINUS

$40.00 COPAY 0 YES YES STARband

Filyaw SC/USA Companion Healthcare (BC/BS) 100% DME with $20

copay 1, company is self insured yes yes 2 DOC Bands (1st is paid for

awaiting news on 2nd)

& Tim Manson Minneapois, MN Blue Cross/Blue Sheild of MN %100 0

No Yes CranioCap

Natasha Gubash Georgia BCBS of AL PPO 90% none no yes DOCband

Florida BCBS Health Options None yet In the process of the 3rd

appeal No No STARband

Niki J. PA BCBS Personal Choice 100% 0 no no STARband

Christopoulos IL BC/BS IL PPO 0 Currently working on first Yes

Yes DOCband

R Forester IL BCBS IL, PPO 0 Currently working on 2nd No Yes DOC

Rhiannon and Marshall Texas, USA BCBS-Texas none yet none yet

vaccum assisted birth yes DOC band

Sara () Snyder Indiana BCBS of IL (PPO) 80% 0 yes yes Starband

Bertling Ma BCBS of MA (HMO & treatment was in Connecticut) 100%

of 2 bands 1 Yes No 2 DOCbands

Sasha Harkins IN Anthem BCBS 80 0 yes yes local helmet - we had to get

pre-approved before getting helmet. they say they'll pay 80%

Dennis NJ Horizon Blue Cross/Blue Shield approx. 67% (after

deductible) 1 Yes Yes DOC

Sohnia Hong TN BCBS PPO (State Employees) 0% so far Currently working

on first No No Local

Sue Ellen NY, USA Blue Cross/Blue Shield 100%! -0-!!!! No No STARband

& JD Lanham Texas/USA Anthem BCBS 80% 0 no yes DOCband

T Boyett Texas BCBS of Texas Health Select (self-funded) 0 2 appeals

then filed grievence through ERS (Employees Retirement System) no yes

DOC Band

TBoyett Texas BCBS Texas Health Select 0 1- working on 2nd no yes DOC

Band

Vicki Meagher IL BlueCross BlueShield of IL 0% Currently working on

first appeal No No DOC Band

Derrick CA/USA Blue Shield PPO about 40% 0 No No DOC

Yi-Fan Fu pa HealthOne of Blue Cross/Blue Shield none yet one appeal so

far starband

andrew mi bcbs all but 10% 0 not to our knowledge no danmar

Amy O'D

> Hi all.

>

> Just wanted to let you know that Blue Cross's Federal Employee Program

> covered $1,222.00 of the $3,000.00 DOC Band for Liliana. I called

> yesterday to find out, and the customer service agent provided me with

> the figures, but I haven't received the letter of explanation yet. We

> will fight to get more coverage. According to my understanding it

> should have been covered at 80% but I admit I'm not sure where we

> stand on meeting our family deductible for the year.

>

> At least the folks at Cranial Tech in ndale, VA have all the

> paperwork lined up to help with the battle. Maybe this is one

> situation where being a severe case can help?

>

> ~

> Liliana 12 months DOC Band since 9/2/05

> Columbia, MD