RE: Advice needed for cephalic ratio and letter of medicalnecessity

[Guest guest]

Have you gotten appoval from your insurance company yet? If not I would reschedule --- if you start treatement before getting the letter of necessity and before insurance approval they can deny you simply for not going through the correct steps.

We had to wait 5 weeks for the insurance company and the neurosurgeon to "connect" (the insurance company had to talk to him in person for some reason) before we could start treatment. Then we did the casting -- insurance denied, but Cigna paid on appeal.

aka Kali

mom to Quinn (11/19/99) DOC graduate for scaphocephalic head shape 10/00----- Original Message -----From: Gianopulos [mailto:m.gianopulos@...]Sent: 12/14/2005 2:26:45 PMPlagiocephaly Subject: RE: Advice needed for cephalic ratio and letter of medicalnecessity

I would probably go ahead with your casting appointment just to get the process under way. Call your CT office and see if they have a problem doing the casting first and then getting the letter the following week.

(mom to Georgia)

-----Original Message-----From: Plagiocephaly [mailto:Plagiocephaly ] On Behalf Of SandySent: Wednesday, December 14, 2005 12:24 PMPlagiocephaly Subject: Advice needed for cephalic ratio and letter of medical necessityMy daughter's Cephalic Index is 103%. I had an appointment to meet with the neurosurgeon tomorrow but they called and rescheduled us for Wed. next week. The problem is, I already made a casting appt. with CT for Tues. next week. I'm eager to get the process started. I was hoping to get the letter of medical necessity this week so I have it when we go into casting. Now I run the risk of going into casting without the letter of medical necessity. However, CT said her CI is 103%, which puts her in the severe category now.Any advice? Should I postpone the casting? I just am eager to get her started ASAP. Part of me thinks we won't have a problem getting a letter of medical necessity from the neurosurgeon because of the 103% for brachy.Christie, it's amazing that Remy went from about 100% to 86%. Wow! I wonder if my daughter's high ratio is also because she has a very wide face, which my husband and I both have.Thanks!Sandy

For more plagio info

[Guest guest]

Have you gotten appoval from your insurance company yet? If not I would reschedule --- if you start treatement before getting the letter of necessity and before insurance approval they can deny you simply for not going through the correct steps.

We had to wait 5 weeks for the insurance company and the neurosurgeon to "connect" (the insurance company had to talk to him in person for some reason) before we could start treatment. Then we did the casting -- insurance denied, but Cigna paid on appeal.

aka Kali

mom to Quinn (11/19/99) DOC graduate for scaphocephalic head shape 10/00----- Original Message -----From: Gianopulos [mailto:m.gianopulos@...]Sent: 12/14/2005 2:26:45 PMPlagiocephaly Subject: RE: Advice needed for cephalic ratio and letter of medicalnecessity

I would probably go ahead with your casting appointment just to get the process under way. Call your CT office and see if they have a problem doing the casting first and then getting the letter the following week.

(mom to Georgia)

-----Original Message-----From: Plagiocephaly [mailto:Plagiocephaly ] On Behalf Of SandySent: Wednesday, December 14, 2005 12:24 PMPlagiocephaly Subject: Advice needed for cephalic ratio and letter of medical necessityMy daughter's Cephalic Index is 103%. I had an appointment to meet with the neurosurgeon tomorrow but they called and rescheduled us for Wed. next week. The problem is, I already made a casting appt. with CT for Tues. next week. I'm eager to get the process started. I was hoping to get the letter of medical necessity this week so I have it when we go into casting. Now I run the risk of going into casting without the letter of medical necessity. However, CT said her CI is 103%, which puts her in the severe category now.Any advice? Should I postpone the casting? I just am eager to get her started ASAP. Part of me thinks we won't have a problem getting a letter of medical necessity from the neurosurgeon because of the 103% for brachy.Christie, it's amazing that Remy went from about 100% to 86%. Wow! I wonder if my daughter's high ratio is also because she has a very wide face, which my husband and I both have.Thanks!Sandy

For more plagio info

[Guest guest]

I haven't gotten the insurance approval yet. Am I just supposed to

call them and ask after I get the letter of medical necessity? I

decided to postpone the casting appointment to see the neurosurgeon

first. I think I'm in denial too - I secretly hope he says that

Sydney doesn't need the band!

Sandy

>

> Have you gotten appoval from your insurance company yet? If not I

would reschedule

> --- if you start treatement before getting the letter of necessity

and before insurance

> approval they can deny you simply for not going through the

correct steps. We

> had to wait 5 weeks for the insurance company and the neurosurgeon

to " connect "

> (the insurance company had to talk to him in person for some

reason) before we could

> start treatment. Then we did the casting -- insurance denied, but

Cigna paid on

> appeal. aka Kali mom to Quinn (11/19/99) DOC graduate for

scaphocephalic

> head shape 10/00

>

>

>

> Advice needed for cephalic ratio and letter of

medical necessity

>

> My daughter's Cephalic Index is 103%. I had an appointment to

meet

> with the neurosurgeon tomorrow but they called and rescheduled us

for

> Wed. next week. The problem is, I already made a casting appt.

with

> CT for Tues. next week. I'm eager to get the process started. I

was

> hoping to get the letter of medical necessity this week so I have

it

> when we go into casting. Now I run the risk of going into casting

> without the letter of medical necessity. However, CT said her CI

is

> 103%, which puts her in the severe category now.

>

> Any advice? Should I postpone the casting? I just am eager to get

> her started ASAP. Part of me thinks we won't have a problem

getting

> a letter of medical necessity from the neurosurgeon because of the

> 103% for brachy.

>

> Christie, it's amazing that Remy went from about 100% to 86%. Wow!

> I wonder if my daughter's high ratio is also because she has a

very

> wide face, which my husband and I both have.

>

> Thanks!

>

> Sandy

>

>

>

>

>

>

>

>

>

> For more plagio info

[Guest guest]

I haven't gotten the insurance approval yet. Am I just supposed to

call them and ask after I get the letter of medical necessity? I

decided to postpone the casting appointment to see the neurosurgeon

first. I think I'm in denial too - I secretly hope he says that

Sydney doesn't need the band!

Sandy

>

> Have you gotten appoval from your insurance company yet? If not I

would reschedule

> --- if you start treatement before getting the letter of necessity

and before insurance

> approval they can deny you simply for not going through the

correct steps. We

> had to wait 5 weeks for the insurance company and the neurosurgeon

to " connect "

> (the insurance company had to talk to him in person for some

reason) before we could

> start treatment. Then we did the casting -- insurance denied, but

Cigna paid on

> appeal. aka Kali mom to Quinn (11/19/99) DOC graduate for

scaphocephalic

> head shape 10/00

>

>

>

> Advice needed for cephalic ratio and letter of

medical necessity

>

> My daughter's Cephalic Index is 103%. I had an appointment to

meet

> with the neurosurgeon tomorrow but they called and rescheduled us

for

> Wed. next week. The problem is, I already made a casting appt.

with

> CT for Tues. next week. I'm eager to get the process started. I

was

> hoping to get the letter of medical necessity this week so I have

it

> when we go into casting. Now I run the risk of going into casting

> without the letter of medical necessity. However, CT said her CI

is

> 103%, which puts her in the severe category now.

>

> Any advice? Should I postpone the casting? I just am eager to get

> her started ASAP. Part of me thinks we won't have a problem

getting

> a letter of medical necessity from the neurosurgeon because of the

> 103% for brachy.

>

> Christie, it's amazing that Remy went from about 100% to 86%. Wow!

> I wonder if my daughter's high ratio is also because she has a

very

> wide face, which my husband and I both have.

>

> Thanks!

>

> Sandy

>

>

>

>

>

>

>

>

>

> For more plagio info

[Guest guest]

It is good that you resecheduled. In most cases they will need to see the

letter of medical necessity before they tell you whether it is approved or not

(usually it can be faxed - in any case don't send them the only copy, make one

for yourself for your records!). In most (not all) cases, it may be denied --

and you then have the option of going through with the treatment, and trying to

appeal to recoup your losses, or fighting before treatment because there is no

other way that you could afford it. Check your policy. Generally once you have

been denied you can go ahead and get the treatment, and then fight at the same

time, paying out of pocket during treatment, but hopefully being reimbursed at

some point (usually after you are finished. By the way - it wasn't until after

the denial that we did the casting -- the way I wrote it below sounds like we

did the casting and then they denied.

There are many insurance hints and tips in the files section here, and many

years ago I put one together for a mom's plagio page (which has a link from the

plagiocephaly information page (http://www.plagiocephaly.org/) -- the insurance

page can be found here http://www.plagiocephaly.org/support/insurance.htm

There are others here who can speak more about the cephalic ratio, etc. How old

is your child? Have you been trying to reposition during this time?

Take care.

Mom to Quinn (born 11/19/99) -- DOC band graduate for scaphocephalic head shape.

Advice needed for cephalic ratio and letter of

> medical necessity

> >

> > My daughter's Cephalic Index is 103%. I had an appointment to

> meet

> > with the neurosurgeon tomorrow but they called and rescheduled us

> for

> > Wed. next week. The problem is, I already made a casting appt.

> with

> > CT for Tues. next week. I'm eager to get the process started. I

> was

> > hoping to get the letter of medical necessity this week so I have

> it

> > when we go into casting. Now I run the risk of going into casting

> > without the letter of medical necessity. However, CT said her CI

> is

> > 103%, which puts her in the severe category now.

> >

> > Any advice? Should I postpone the casting? I just am eager to get

> > her started ASAP. Part of me thinks we won't have a problem

> getting

> > a letter of medical necessity from the neurosurgeon because of the

> > 103% for brachy.

> >

> > Christie, it's amazing that Remy went from about 100% to 86%. Wow!

> > I wonder if my daughter's high ratio is also because she has a

> very

> > wide face, which my husband and I both have.

> >

> > Thanks!

> >

> > Sandy

> >

> >

> >

> >

> >

> >

> >

> >

> >

> > For more plagio info

[Guest guest]

It is good that you resecheduled. In most cases they will need to see the

letter of medical necessity before they tell you whether it is approved or not

(usually it can be faxed - in any case don't send them the only copy, make one

for yourself for your records!). In most (not all) cases, it may be denied --

and you then have the option of going through with the treatment, and trying to

appeal to recoup your losses, or fighting before treatment because there is no

other way that you could afford it. Check your policy. Generally once you have

been denied you can go ahead and get the treatment, and then fight at the same

time, paying out of pocket during treatment, but hopefully being reimbursed at

some point (usually after you are finished. By the way - it wasn't until after

the denial that we did the casting -- the way I wrote it below sounds like we

did the casting and then they denied.

There are many insurance hints and tips in the files section here, and many

years ago I put one together for a mom's plagio page (which has a link from the

plagiocephaly information page (http://www.plagiocephaly.org/) -- the insurance

page can be found here http://www.plagiocephaly.org/support/insurance.htm

There are others here who can speak more about the cephalic ratio, etc. How old

is your child? Have you been trying to reposition during this time?

Take care.

Mom to Quinn (born 11/19/99) -- DOC band graduate for scaphocephalic head shape.

Advice needed for cephalic ratio and letter of

> medical necessity

> >

> > My daughter's Cephalic Index is 103%. I had an appointment to

> meet

> > with the neurosurgeon tomorrow but they called and rescheduled us

> for

> > Wed. next week. The problem is, I already made a casting appt.

> with

> > CT for Tues. next week. I'm eager to get the process started. I

> was

> > hoping to get the letter of medical necessity this week so I have

> it

> > when we go into casting. Now I run the risk of going into casting

> > without the letter of medical necessity. However, CT said her CI

> is

> > 103%, which puts her in the severe category now.

> >

> > Any advice? Should I postpone the casting? I just am eager to get

> > her started ASAP. Part of me thinks we won't have a problem

> getting

> > a letter of medical necessity from the neurosurgeon because of the

> > 103% for brachy.

> >

> > Christie, it's amazing that Remy went from about 100% to 86%. Wow!

> > I wonder if my daughter's high ratio is also because she has a

> very

> > wide face, which my husband and I both have.

> >

> > Thanks!

> >

> > Sandy

> >

> >

> >

> >

> >

> >

> >

> >

> >

> > For more plagio info

[Guest guest]

Sandy--

Maybe you should call your insurance carrier. It seems that my experience was different than the other answer you received. After my visit with our cranial facial surgeon where I received both the prescription and letter of medicl necessity I called my insurance to find out about our coverage (wanted to know up front before going ahead with casting, etc.) Insurance told me they need more info. So I called surgeon's office to get more info. Was told that when we meet orthotist, measurements would be taken and they would be submitted for more info. Then I called the orthotist that we were planning on using. She said to come for 1st visit, she would submit measurements, letter and script all at one time. At our first visit, she told me that based on my insurance carrier and Georgia's measurements she expected us to receive full coverage. Georgia had her casting that day as well. So you see, we actually completely started the process before receiving official approval and we have indeed received 100% coverage. I think you should talk to both insurance and ortho to make sure you understand the process for your specific situation.

Good luck,

(mom to Georgia, DDH/plagio, Starband grad 11/05)

-----Original Message-----From: Plagiocephaly [mailto:Plagiocephaly ] On Behalf Of SandySent: Thursday, December 15, 2005 1:12 AMPlagiocephaly Subject: Re: Advice needed for cephalic ratio and letter of medicalnecessityI haven't gotten the insurance approval yet. Am I just supposed to call them and ask after I get the letter of medical necessity? I decided to postpone the casting appointment to see the neurosurgeon first. I think I'm in denial too - I secretly hope he says that Sydney doesn't need the band!Sandy>> Have you gotten appoval from your insurance company yet? If not I would reschedule> --- if you start treatement before getting the letter of necessity and before insurance> approval they can deny you simply for not going through the correct steps. We> had to wait 5 weeks for the insurance company and the neurosurgeon to "connect"> (the insurance company had to talk to him in person for some reason) before we could> start treatment. Then we did the casting -- insurance denied, but Cigna paid on> appeal. aka Kali mom to Quinn (11/19/99) DOC graduate for scaphocephalic> head shape 10/00> > > > Advice needed for cephalic ratio and letter of medical necessity> > My daughter's Cephalic Index is 103%. I had an appointment to meet > with the neurosurgeon tomorrow but they called and rescheduled us for > Wed. next week. The problem is, I already made a casting appt. with > CT for Tues. next week. I'm eager to get the process started. I was > hoping to get the letter of medical necessity this week so I have it > when we go into casting. Now I run the risk of going into casting > without the letter of medical necessity. However, CT said her CI is > 103%, which puts her in the severe category now.> > Any advice? Should I postpone the casting? I just am eager to get > her started ASAP. Part of me thinks we won't have a problem getting > a letter of medical necessity from the neurosurgeon because of the > 103% for brachy.> > Christie, it's amazing that Remy went from about 100% to 86%. Wow! > I wonder if my daughter's high ratio is also because she has a very > wide face, which my husband and I both have.> > Thanks!> > Sandy > > > > > > > > > > For more plagio info

[Guest guest]

Sandy--

Maybe you should call your insurance carrier. It seems that my experience was different than the other answer you received. After my visit with our cranial facial surgeon where I received both the prescription and letter of medicl necessity I called my insurance to find out about our coverage (wanted to know up front before going ahead with casting, etc.) Insurance told me they need more info. So I called surgeon's office to get more info. Was told that when we meet orthotist, measurements would be taken and they would be submitted for more info. Then I called the orthotist that we were planning on using. She said to come for 1st visit, she would submit measurements, letter and script all at one time. At our first visit, she told me that based on my insurance carrier and Georgia's measurements she expected us to receive full coverage. Georgia had her casting that day as well. So you see, we actually completely started the process before receiving official approval and we have indeed received 100% coverage. I think you should talk to both insurance and ortho to make sure you understand the process for your specific situation.

Good luck,

(mom to Georgia, DDH/plagio, Starband grad 11/05)

-----Original Message-----From: Plagiocephaly [mailto:Plagiocephaly ] On Behalf Of SandySent: Thursday, December 15, 2005 1:12 AMPlagiocephaly Subject: Re: Advice needed for cephalic ratio and letter of medicalnecessityI haven't gotten the insurance approval yet. Am I just supposed to call them and ask after I get the letter of medical necessity? I decided to postpone the casting appointment to see the neurosurgeon first. I think I'm in denial too - I secretly hope he says that Sydney doesn't need the band!Sandy>> Have you gotten appoval from your insurance company yet? If not I would reschedule> --- if you start treatement before getting the letter of necessity and before insurance> approval they can deny you simply for not going through the correct steps. We> had to wait 5 weeks for the insurance company and the neurosurgeon to "connect"> (the insurance company had to talk to him in person for some reason) before we could> start treatment. Then we did the casting -- insurance denied, but Cigna paid on> appeal. aka Kali mom to Quinn (11/19/99) DOC graduate for scaphocephalic> head shape 10/00> > > > Advice needed for cephalic ratio and letter of medical necessity> > My daughter's Cephalic Index is 103%. I had an appointment to meet > with the neurosurgeon tomorrow but they called and rescheduled us for > Wed. next week. The problem is, I already made a casting appt. with > CT for Tues. next week. I'm eager to get the process started. I was > hoping to get the letter of medical necessity this week so I have it > when we go into casting. Now I run the risk of going into casting > without the letter of medical necessity. However, CT said her CI is > 103%, which puts her in the severe category now.> > Any advice? Should I postpone the casting? I just am eager to get > her started ASAP. Part of me thinks we won't have a problem getting > a letter of medical necessity from the neurosurgeon because of the > 103% for brachy.> > Christie, it's amazing that Remy went from about 100% to 86%. Wow! > I wonder if my daughter's high ratio is also because she has a very > wide face, which my husband and I both have.> > Thanks!> > Sandy > > > > > > > > > > For more plagio info

[Guest guest]

Thanks for the links. Sydney is 4.5 months old. I have been trying

repo. We've been trying to keep her off her head during the day.

At night though, the attempts to turn her head last maybe 15 min. -

1 hr. before she turns her head back. It's tiring - I end up barely

sleeping at night....

Sandy

>

> It is good that you resecheduled. In most cases they will need to

see the letter of medical necessity before they tell you whether it

is approved or not (usually it can be faxed - in any case don't send

them the only copy, make one for yourself for your records!). In

most (not all) cases, it may be denied -- and you then have the

option of going through with the treatment, and trying to appeal to

recoup your losses, or fighting before treatment because there is no

other way that you could afford it. Check your policy. Generally

once you have been denied you can go ahead and get the treatment,

and then fight at the same time, paying out of pocket during

treatment, but hopefully being reimbursed at some point (usually

after you are finished. By the way - it wasn't until after the

denial that we did the casting -- the way I wrote it below sounds

like we did the casting and then they denied.

>

> There are many insurance hints and tips in the files section here,

and many years ago I put one together for a mom's plagio page (which

has a link from the plagiocephaly information page

(http://www.plagiocephaly.org/) -- the insurance page can be found

here http://www.plagiocephaly.org/support/insurance.htm

>

> There are others here who can speak more about the cephalic ratio,

etc. How old is your child? Have you been trying to reposition

during this time?

>

> Take care.

>

> Mom to Quinn (born 11/19/99) -- DOC band graduate for

scaphocephalic head shape.

>

[Guest guest]

Thanks for the links. Sydney is 4.5 months old. I have been trying

repo. We've been trying to keep her off her head during the day.

At night though, the attempts to turn her head last maybe 15 min. -

1 hr. before she turns her head back. It's tiring - I end up barely

sleeping at night....

Sandy

>

> It is good that you resecheduled. In most cases they will need to

see the letter of medical necessity before they tell you whether it

is approved or not (usually it can be faxed - in any case don't send

them the only copy, make one for yourself for your records!). In

most (not all) cases, it may be denied -- and you then have the

option of going through with the treatment, and trying to appeal to

recoup your losses, or fighting before treatment because there is no

other way that you could afford it. Check your policy. Generally

once you have been denied you can go ahead and get the treatment,

and then fight at the same time, paying out of pocket during

treatment, but hopefully being reimbursed at some point (usually

after you are finished. By the way - it wasn't until after the

denial that we did the casting -- the way I wrote it below sounds

like we did the casting and then they denied.

>

> There are many insurance hints and tips in the files section here,

and many years ago I put one together for a mom's plagio page (which

has a link from the plagiocephaly information page

(http://www.plagiocephaly.org/) -- the insurance page can be found

here http://www.plagiocephaly.org/support/insurance.htm

>

> There are others here who can speak more about the cephalic ratio,

etc. How old is your child? Have you been trying to reposition

during this time?

>

> Take care.

>

> Mom to Quinn (born 11/19/99) -- DOC band graduate for

scaphocephalic head shape.

>