Aetna

[Guest guest]

Just thought I would pass this on...

I was at Cranial Technologies in No. Virginia yesterday and was told

that CT signed a contract with Aetna as an in-network provider as of

March 1, 2006.

h

[Guest guest]

Just thought I would pass this on...

I was at Cranial Technologies in No. Virginia yesterday and was told

that CT signed a contract with Aetna as an in-network provider as of

March 1, 2006.

h

[Guest guest]

,

We started the process to get our daughter her first helmet when she was 9 months old. We have AETNA for insurance. At the time, Cranial Tech was out of network (by the time she got her second band, AETNA had Cranial Tech as in network). Being out of network, it took longer for them to pay Cranial Tech (a couple of months), the second time, being in network, they paid Cranial Tech within 4 weeks. It did not affect the pre-cert process though.

Anyway, being in similar shoes as you, I'll tell you what I did. First, go here and look up all of AETNA's requirements for a cranial molding device/helmet:

http://www.aetna.com/cpb/medical/data/300_399/0379.html

The insurance person at Cranial Tech had a lot of experience with AETNA, so she told me exactly what I needed to do to speed up the process. First off, you need to get a pre-certification from AETNA. She said AETNA is known for being picky... they often denies the pre-certification if people have already started the casting/scanning process. So we had to wait until the pre-cert approval came through before we could go through the casting.

Here are the other tips she gave me to make it go as quickly as possible, based on her experience with those who have been denied and approved:

First, they want a prescription for the helmet. I got one from my pediatrician. The cranial tech insurance lady told me that AETNA can nit-pick, and sometimes they will deny based on something silly, like they want the prescription from a specialist (or vice versa, they want the script from someone who knows her history well, like a pediatrician LOL). So I got the cranial facial doctor/specialist to write a script too. I HAND carried two prescriptions to the insurance lady at Cranial Tech. So she had two prescriptions to cover our bases- one from her pediatrician, one from the specialist.

Secondly, she said we need a letter of medical necessity. In this letter, she said it's critical that they use the specific wording stating that repositioning was tried for more than two months with no success/improvement ('several months' , 'couple of months', 'many months' won't suffice... she said she gets claims denied by AETNA frequently based on their pickiness for precise wording, when doctors don't write down the number of months and that there was no success).... and it needs to be from someone who has a history of her medically (her pediatrician) as well as the specialist (the cranial facial doctor). I told her pediatrician and she specifically wrote that repositioning had been tried for 6 months with no success. I hand carried the letter of medical necessity from my pediatrician (my cranial facial doctor faxed his to cranial tech- which I called and verified). AETNA does not require two letters (nor prescriptions), but I did so, on advice from this woman, based on her billing experience with them, just to cover ourselves, and to speed the process along.

Lastly, she said she has to meet one measurement (see the link above for the three measurements... as long as just one of those is higher than 6mm, then they consider the helmet necessary). That measurement/asymmetry has to be at least 7mm or higher; and there are three ways/measurements that it can be met. I was told my daughter's asymmetry was mild, she didn't need a helmet by a previous specialist. So I was afraid she would measure 6mm or lower (and AETNA would deny us). But as it turned out, she had 11mm of asymmetry on one of those measurements, so she qualified.

Cranial Tech submitted the claim on a Friday with all the info I gave her. The following Friday, AETNA approved us. Crania Tech was out of network at the time, but cranial tech casted her as soon as the approval came through (thanks to me calling cranial tech asking everyday if it had come through) and she got her helmet two weeks after it was casted. Cranial Tech didn't get paid for a while though, but they had the pre-cert so they were all set.

Hope that helps you. My advice to you would be, to take the reigns and do the legwork yourself and cover all your bases... hold their hand the whole way so they can get it done. Call them to check every step of the way that they have received the info, submitted the claim, and when they have heard back. Ask AETNA what to do to speed up the pre-cert process (they gave us a separate fax number and we were told to mark it urgent); call AETNA after the pre-cert has been filed to see what stage they're in... if they need anything else (be really nice and cooperative... kill them with kindness is what I say LOL). We just did this recently for a surgery for my daughter, and instead of the typical 4-6 week wait for the pre-determination, they gave us an answer within ten days.

Hope that helps... just my two cents.....best wishes to you.

Colleen

Peyton 23 months (Graduate: 2 DOCbands 10-18months)

Aetna

I've been lurking on the board for a few weeks now, it has been incredibly helpful. My daughter is almost 5mos. She never had the perfectly round head since birth, but I noticed that her right back side was flattening. She was dx with plagio at 2 mos. we've been repositioning and it has improved, but it is definitely still flat. We have an appt. with neuro. but not until dec. I've consulted with Hanger and she definitely qualifies 10mm. We are going to cranial tech on mon. for another opinion. My ped is awesome and she said she will give me what ever I need to get things going now rather than wait until dec. Has anyone dealth with Aetna? I have a copy of their coverage and we qualify at 10mm. Any advice on how to speed things along? We have our 2mos. of repositioning documented by the ped, she agrees to write the script...anything else? Family and friends are having a hard time with this idea, but as her mother I will do whatever it takes to make sure I do what is best. Thanks for such a wonderful board! __________________________________________________

[Guest guest]

Colleen- Thank you so much for the Aetna info. Were you happy with Cranial Tech? We will be going to the one in Connecticut. We live in Mass, but it is only about an hour away. You have been an unbelievable help, I really appreciate it!!!">^.^<" <two_soulmates@...> wrote: , We started the process to get our daughter her first helmet

when she was 9 months old. We have AETNA for insurance. At the time, Cranial Tech was out of network (by the time she got her second band, AETNA had Cranial Tech as in network). Being out of network, it took longer for them to pay Cranial Tech (a couple of months), the second time, being in network, they paid Cranial Tech within 4 weeks. It did not affect the pre-cert process though. Anyway, being in similar shoes as you, I'll tell you what I did. First, go here and look up all of AETNA's requirements for a cranial molding device/helmet: http://www.aetna.com/cpb/medical/data/300_399/0379.html The insurance person at Cranial Tech had a lot of experience with

AETNA, so she told me exactly what I needed to do to speed up the process. First off, you need to get a pre-certification from AETNA. She said AETNA is known for being picky... they often denies the pre-certification if people have already started the casting/scanning process. So we had to wait until the pre-cert approval came through before we could go through the casting. Here are the other tips she gave me to make it go as quickly as possible, based on her experience with those who have been denied and approved: First, they want a prescription for the helmet. I got one from my pediatrician. The cranial tech insurance lady told me that AETNA can nit-pick, and sometimes they will deny based on something silly, like they want the prescription from a specialist (or vice

versa, they want the script from someone who knows her history well, like a pediatrician LOL). So I got the cranial facial doctor/specialist to write a script too. I HAND carried two prescriptions to the insurance lady at Cranial Tech. So she had two prescriptions to cover our bases- one from her pediatrician, one from the specialist. Secondly, she said we need a letter of medical necessity. In this letter, she said it's critical that they use the specific wording stating that repositioning was tried for more than two months with no success/improvement ('several months' , 'couple of months', 'many months' won't suffice... she said she gets claims denied by AETNA frequently based on their pickiness for precise wording, when doctors don't write down the number of months and that there was no success).... and it needs to be from

someone who has a history of her medically (her pediatrician) as well as the specialist (the cranial facial doctor). I told her pediatrician and she specifically wrote that repositioning had been tried for 6 months with no success. I hand carried the letter of medical necessity from my pediatrician (my cranial facial doctor faxed his to cranial tech- which I called and verified). AETNA does not require two letters (nor prescriptions), but I did so, on advice from this woman, based on her billing experience with them, just to cover ourselves, and to speed the process along. Lastly, she said she has to meet one measurement (see the link above for the three measurements... as long as just one of those is higher than 6mm, then they consider the helmet necessary). That measurement/asymmetry has to be at least 7mm or higher; and there are three ways/measurements that it

can be met. I was told my daughter's asymmetry was mild, she didn't need a helmet by a previous specialist. So I was afraid she would measure 6mm or lower (and AETNA would deny us). But as it turned out, she had 11mm of asymmetry on one of those measurements, so she qualified. Cranial Tech submitted the claim on a Friday with all the info I gave her. The following Friday, AETNA approved us. Crania Tech was out of network at the time, but cranial tech casted her as soon as the approval came through (thanks to me calling cranial tech asking everyday if it had come through) and she got her helmet two weeks after it was casted. Cranial Tech didn't get paid for a while though, but they had the pre-cert so they were all set. Hope that helps you. My advice to you would be, to take the reigns

and do the legwork yourself and cover all your bases... hold their hand the whole way so they can get it done. Call them to check every step of the way that they have received the info, submitted the claim, and when they have heard back. Ask AETNA what to do to speed up the pre-cert process (they gave us a separate fax number and we were told to mark it urgent); call AETNA after the pre-cert has been filed to see what stage they're in... if they need anything else (be really nice and cooperative... kill them with kindness is what I say LOL). We just did this recently for a surgery for my daughter, and instead of the typical 4-6 week wait for the pre-determination, they gave us an answer within ten days. Hope that helps... just my two cents.....best wishes to you. Colleen Peyton 23 months (Graduate: 2 DOCbands 10-18months) Aetna I've been lurking on the board for a few weeks now, it has been incredibly helpful. My daughter is almost 5mos. She never had the perfectly round head

since birth, but I noticed that her right back side was flattening. She was dx with plagio at 2 mos. we've been repositioning and it has improved, but it is definitely still flat. We have an appt. with neuro. but not until dec. I've consulted with Hanger and she definitely qualifies 10mm. We are going to cranial tech on mon. for another opinion. My ped is awesome and she said she will give me what ever I need to get things going now rather than wait until dec. Has anyone dealth with Aetna? I have a copy of their coverage and we qualify at 10mm. Any advice on how to speed things along? We have our 2mos. of repositioning documented by the ped, she agrees to write the script...anything else? Family and friends are having a hard time with this idea, but as her mother I will do whatever it takes to make sure I do what is best. Thanks for such a wonderful board! __________________________________________________