Won appeal, but insurance only paid 800.00...now what?

[Guest guest]

Hi,

I posted a few weeks back that we won our second level appeal with our

insurance company Capital Blue Cross (PA). The check arrived in the

mail , but it was only for 800.00. After calling my insurance company,

I was told that that was the reasonable and comparable price for the

" helmet " in the local area. They claimed the local area they were

referring to was Virginia (northern) since we went to CT in VA. As you

all know the DOC Band costs 3000.00. They paid 80% of $1000.00 (the

reasonable, comparable price).

I know some people here have had the same thing happen. I almost feel

because we won our appeal that they are sort of having the last laugh

by only paying us 800.00.

Can I appeal the decision by them to only reimburse us 800.00? When I

called the insurance company today, the customer service rep said, no.

What other action can I take?

And lastly, is there anyone in the VA area, who knows some other

providers that I can call to get prices?

I did call CT today and they said medicaid's reasonable and comparable

price for the DOC Band is 1600.00.

After all the work we did putting together two appeals, I cannot

believe we only received a check for 800.00. The customer service rep

actually had the gull to say that, " they made an exemption by paying

for any of the DOC Band. " I reminded her very quickly that we won our

appeal.

Help please!

Thanks,

Kendra

[Guest guest]

Hi,

I posted a few weeks back that we won our second level appeal with our

insurance company Capital Blue Cross (PA). The check arrived in the

mail , but it was only for 800.00. After calling my insurance company,

I was told that that was the reasonable and comparable price for the

" helmet " in the local area. They claimed the local area they were

referring to was Virginia (northern) since we went to CT in VA. As you

all know the DOC Band costs 3000.00. They paid 80% of $1000.00 (the

reasonable, comparable price).

I know some people here have had the same thing happen. I almost feel

because we won our appeal that they are sort of having the last laugh

by only paying us 800.00.

Can I appeal the decision by them to only reimburse us 800.00? When I

called the insurance company today, the customer service rep said, no.

What other action can I take?

And lastly, is there anyone in the VA area, who knows some other

providers that I can call to get prices?

I did call CT today and they said medicaid's reasonable and comparable

price for the DOC Band is 1600.00.

After all the work we did putting together two appeals, I cannot

believe we only received a check for 800.00. The customer service rep

actually had the gull to say that, " they made an exemption by paying

for any of the DOC Band. " I reminded her very quickly that we won our

appeal.

Help please!

Thanks,

Kendra