Guest guest Posted January 6, 2006 Report Share Posted January 6, 2006 We go monday to dallas to the consult and they made an appt for casting to if he needs it. We have to be there @ 8:30am... i have few questions, why do i have to pay upfront. my insuance will pay 80% up to 1000. we were told it was 3,000. for everything so we will be out of pocket about 2300. we fig. i am gonna appeal. I have no idea where to start. But i didnt understand why we have to pay or set up payment plan. Yall i am getting more and more scared. They cut the internet off at work so i can only get on at home which isnt much. i do miss reading yall post everyday. any tips. thanks yall Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2006 Report Share Posted January 6, 2006 We go monday to dallas to the consult and they made an appt for casting to if he needs it. We have to be there @ 8:30am... i have few questions, why do i have to pay upfront. my insuance will pay 80% up to 1000. we were told it was 3,000. for everything so we will be out of pocket about 2300. we fig. i am gonna appeal. I have no idea where to start. But i didnt understand why we have to pay or set up payment plan. Yall i am getting more and more scared. They cut the internet off at work so i can only get on at home which isnt much. i do miss reading yall post everyday. any tips. thanks yall Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2006 Report Share Posted January 6, 2006 Hello. I'm not sure why you would have to pay upfront if Insurance gave their approval. Did your Ins say that they approved the DOC? Maybe some of the DOC parents will know more about this for you. When got her band, we didn't have to pay a cent until the Insurance paid their part, then we paid our co insurance which was only $127 of the $2500 that was billed. Good luck at the consult. Let us know how it goes. Jen --- In Plagiocephaly , " " <marpate2004@y...> wrote: > > We go monday to dallas to the consult and they made an appt for casting > to if he needs it. > We have to be there @ 8:30am... > i have few questions, why do i have to pay upfront. my insuance will > pay 80% up to 1000. we were told it was 3,000. for everything so we > will be out of pocket about 2300. we fig. i am gonna appeal. I have no > idea where to start. But i didnt understand why we have to pay or set > up payment plan. > Yall i am getting more and more scared. They cut the internet off at > work so i can only get on at home which isnt much. > i do miss reading yall post everyday. any tips. thanks yall > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2006 Report Share Posted January 6, 2006 Hello. I'm not sure why you would have to pay upfront if Insurance gave their approval. Did your Ins say that they approved the DOC? Maybe some of the DOC parents will know more about this for you. When got her band, we didn't have to pay a cent until the Insurance paid their part, then we paid our co insurance which was only $127 of the $2500 that was billed. Good luck at the consult. Let us know how it goes. Jen --- In Plagiocephaly , " " <marpate2004@y...> wrote: > > We go monday to dallas to the consult and they made an appt for casting > to if he needs it. > We have to be there @ 8:30am... > i have few questions, why do i have to pay upfront. my insuance will > pay 80% up to 1000. we were told it was 3,000. for everything so we > will be out of pocket about 2300. we fig. i am gonna appeal. I have no > idea where to start. But i didnt understand why we have to pay or set > up payment plan. > Yall i am getting more and more scared. They cut the internet off at > work so i can only get on at home which isnt much. > i do miss reading yall post everyday. any tips. thanks yall > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2006 Report Share Posted January 6, 2006 Hi , I went to CranialTech and didn't have to pay upfront but at the beginning went for a consult for a helmet through another company in D.C. and they were going to make us pay upfront even though our insurance would cover 100%. I couldn't understand it because I talked to the insurance and they would have cleared it before she even had her helmet. When I questioned the helmet place - the guy said it is because sometimes insurance companies do not pay as much as they first say they will - basically he came out with he didn't want to be stuck with us not paying if the insurance company failed payment. He offered different payment options - but first I was offended that he would think we wouldn't pay (perhaps it happened with others in the past) but also, it made me feel like he put getting money before getting Bella the help she needed. It is your right to ask direct questions as to why this is the way the place in Dallas does business. I am glad we got the answers - it also gave his " personality " a chance to surface. For me, I just had a feeling in my gut and did not feel comfortable with those business tactics. Just make sure you feel comfortable before you commit - it's a big decision and we know what it feels like leading up to the consult anyway. You deserve the best treatment - I'm sure you've done your research on the Band/Helmet options in your area. But, if there's more than one option - it may be helpful to get more than one consult if possible - it helped us greatly. Good luck, and please post with updates, I'll be checking to see how it goes! Sincerely, April (mom to Bella 6 1/2 months, DOC Band 01/04/06, polis, MD) --- In Plagiocephaly , " " <marpate2004@y...> wrote: > > We go monday to dallas to the consult and they made an appt for casting > to if he needs it. > We have to be there @ 8:30am... > i have few questions, why do i have to pay upfront. my insuance will > pay 80% up to 1000. we were told it was 3,000. for everything so we > will be out of pocket about 2300. we fig. i am gonna appeal. I have no > idea where to start. But i didnt understand why we have to pay or set > up payment plan. > Yall i am getting more and more scared. They cut the internet off at > work so i can only get on at home which isnt much. > i do miss reading yall post everyday. any tips. thanks yall > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2006 Report Share Posted January 6, 2006 Hi , I went to CranialTech and didn't have to pay upfront but at the beginning went for a consult for a helmet through another company in D.C. and they were going to make us pay upfront even though our insurance would cover 100%. I couldn't understand it because I talked to the insurance and they would have cleared it before she even had her helmet. When I questioned the helmet place - the guy said it is because sometimes insurance companies do not pay as much as they first say they will - basically he came out with he didn't want to be stuck with us not paying if the insurance company failed payment. He offered different payment options - but first I was offended that he would think we wouldn't pay (perhaps it happened with others in the past) but also, it made me feel like he put getting money before getting Bella the help she needed. It is your right to ask direct questions as to why this is the way the place in Dallas does business. I am glad we got the answers - it also gave his " personality " a chance to surface. For me, I just had a feeling in my gut and did not feel comfortable with those business tactics. Just make sure you feel comfortable before you commit - it's a big decision and we know what it feels like leading up to the consult anyway. You deserve the best treatment - I'm sure you've done your research on the Band/Helmet options in your area. But, if there's more than one option - it may be helpful to get more than one consult if possible - it helped us greatly. Good luck, and please post with updates, I'll be checking to see how it goes! Sincerely, April (mom to Bella 6 1/2 months, DOC Band 01/04/06, polis, MD) --- In Plagiocephaly , " " <marpate2004@y...> wrote: > > We go monday to dallas to the consult and they made an appt for casting > to if he needs it. > We have to be there @ 8:30am... > i have few questions, why do i have to pay upfront. my insuance will > pay 80% up to 1000. we were told it was 3,000. for everything so we > will be out of pocket about 2300. we fig. i am gonna appeal. I have no > idea where to start. But i didnt understand why we have to pay or set > up payment plan. > Yall i am getting more and more scared. They cut the internet off at > work so i can only get on at home which isnt much. > i do miss reading yall post everyday. any tips. thanks yall > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2006 Report Share Posted January 6, 2006 I can appreciate the confusion with insurance coverage issues. Typically when you call for benefits, they will give you " general " benefit information, which is always subject to medical necessity. In order to find out if they consider the service medically necessary, you need to go through the formal authorization process where the medical review department determines coverage by looking at your child's records. If you wait for an insurance approval before starting treatment, only the portion not paid by insurance will be due. However by proceeding without formal approval or denial, you need to be prepared that you will possibly be responsible for the entire treatment charge. Sandy Bruno Patient Relations Coordinator > > > > We go monday to dallas to the consult and they made an appt for > casting > > to if he needs it. > > We have to be there @ 8:30am... > > i have few questions, why do i have to pay upfront. my insuance will > > pay 80% up to 1000. we were told it was 3,000. for everything so we > > will be out of pocket about 2300. we fig. i am gonna appeal. I have > no > > idea where to start. But i didnt understand why we have to pay or set > > up payment plan. > > Yall i am getting more and more scared. They cut the internet off at > > work so i can only get on at home which isnt much. > > i do miss reading yall post everyday. any tips. thanks yall > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2006 Report Share Posted January 6, 2006 I can appreciate the confusion with insurance coverage issues. Typically when you call for benefits, they will give you " general " benefit information, which is always subject to medical necessity. In order to find out if they consider the service medically necessary, you need to go through the formal authorization process where the medical review department determines coverage by looking at your child's records. If you wait for an insurance approval before starting treatment, only the portion not paid by insurance will be due. However by proceeding without formal approval or denial, you need to be prepared that you will possibly be responsible for the entire treatment charge. Sandy Bruno Patient Relations Coordinator > > > > We go monday to dallas to the consult and they made an appt for > casting > > to if he needs it. > > We have to be there @ 8:30am... > > i have few questions, why do i have to pay upfront. my insuance will > > pay 80% up to 1000. we were told it was 3,000. for everything so we > > will be out of pocket about 2300. we fig. i am gonna appeal. I have > no > > idea where to start. But i didnt understand why we have to pay or set > > up payment plan. > > Yall i am getting more and more scared. They cut the internet off at > > work so i can only get on at home which isnt much. > > i do miss reading yall post everyday. any tips. thanks yall > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2006 Report Share Posted January 6, 2006 We had to set up a payment plan when we got treatment too, even though we had insurance approval. We had to just pay for the casting up front and then made the payments up to the amount insurance would not cover. I think it would be crazy to not get the money for at least the casting up front, what if you have the casting done and then backed out? They would be out the money for the casting process, the headmold being made and depending when you backed out, the band being made. There is nothing to be afraid of, the consult is very simple and quick. They have it down to a science,lol. The casting process is over in about 15 minutes and then they get to enjoy a nice relaxing bath. I know the thought of getting a band can be scary but you have to tell yourself you are doing what is best for your baby. Trust me these bands bother us parents more than the babies,lol. The babies adjust pretty quick and you won't believe how cute they are in thier bands. Good Luck and try and relax. CAROLG --- In Plagiocephaly , " " <marpate2004@y...> wrote: > > We go monday to dallas to the consult and they made an appt for casting > to if he needs it. > We have to be there @ 8:30am... > i have few questions, why do i have to pay upfront. my insuance will > pay 80% up to 1000. we were told it was 3,000. for everything so we > will be out of pocket about 2300. we fig. i am gonna appeal. I have no > idea where to start. But i didnt understand why we have to pay or set > up payment plan. > Yall i am getting more and more scared. They cut the internet off at > work so i can only get on at home which isnt much. > i do miss reading yall post everyday. any tips. thanks yall > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2006 Report Share Posted January 6, 2006 We had to set up a payment plan when we got treatment too, even though we had insurance approval. We had to just pay for the casting up front and then made the payments up to the amount insurance would not cover. I think it would be crazy to not get the money for at least the casting up front, what if you have the casting done and then backed out? They would be out the money for the casting process, the headmold being made and depending when you backed out, the band being made. There is nothing to be afraid of, the consult is very simple and quick. They have it down to a science,lol. The casting process is over in about 15 minutes and then they get to enjoy a nice relaxing bath. I know the thought of getting a band can be scary but you have to tell yourself you are doing what is best for your baby. Trust me these bands bother us parents more than the babies,lol. The babies adjust pretty quick and you won't believe how cute they are in thier bands. Good Luck and try and relax. CAROLG --- In Plagiocephaly , " " <marpate2004@y...> wrote: > > We go monday to dallas to the consult and they made an appt for casting > to if he needs it. > We have to be there @ 8:30am... > i have few questions, why do i have to pay upfront. my insuance will > pay 80% up to 1000. we were told it was 3,000. for everything so we > will be out of pocket about 2300. we fig. i am gonna appeal. I have no > idea where to start. But i didnt understand why we have to pay or set > up payment plan. > Yall i am getting more and more scared. They cut the internet off at > work so i can only get on at home which isnt much. > i do miss reading yall post everyday. any tips. thanks yall > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2006 Report Share Posted January 6, 2006 Hi, You shouldn't have to pay the entire balance upfront, but instead they should let you go on a payment plan for the remaining balance. We put the payments on a 0%APR credit card while we appealed and it was very easy to get the charges refunded. They have to make sure they're getting some form of payment before they'll cast and have the band made. Good luck on your appeal for the rest of the costs and also good luck at your consult and possible casting. , mom to Hannah, DOCgrad Cape Cod, Ma http://hannahsnoggin.typepad.com --- In Plagiocephaly , " " <marpate2004@y...> wrote: > > We go monday to dallas to the consult and they made an appt for casting > to if he needs it. > We have to be there @ 8:30am... > i have few questions, why do i have to pay upfront. my insuance will > pay 80% up to 1000. we were told it was 3,000. for everything so we > will be out of pocket about 2300. we fig. i am gonna appeal. I have no > idea where to start. But i didnt understand why we have to pay or set > up payment plan. > Yall i am getting more and more scared. They cut the internet off at > work so i can only get on at home which isnt much. > i do miss reading yall post everyday. any tips. thanks yall > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2006 Report Share Posted January 6, 2006 Hi, You shouldn't have to pay the entire balance upfront, but instead they should let you go on a payment plan for the remaining balance. We put the payments on a 0%APR credit card while we appealed and it was very easy to get the charges refunded. They have to make sure they're getting some form of payment before they'll cast and have the band made. Good luck on your appeal for the rest of the costs and also good luck at your consult and possible casting. , mom to Hannah, DOCgrad Cape Cod, Ma http://hannahsnoggin.typepad.com --- In Plagiocephaly , " " <marpate2004@y...> wrote: > > We go monday to dallas to the consult and they made an appt for casting > to if he needs it. > We have to be there @ 8:30am... > i have few questions, why do i have to pay upfront. my insuance will > pay 80% up to 1000. we were told it was 3,000. for everything so we > will be out of pocket about 2300. we fig. i am gonna appeal. I have no > idea where to start. But i didnt understand why we have to pay or set > up payment plan. > Yall i am getting more and more scared. They cut the internet off at > work so i can only get on at home which isnt much. > i do miss reading yall post everyday. any tips. thanks yall > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2006 Report Share Posted January 6, 2006 they did tel me would could work out a payment plan, i was just kinda shocked when she said: do u want to pay the whole 3000. or 2700 or we can work a payment plan. I wasnt expecting it i guess. we have gotten together 1900. so far. Thanks to family and church. So if we have to pay 2300. then we got almost that. I am gonna appeal Ins. sfor sure. i just know dont where to began. > > > > We go monday to dallas to the consult and they made an appt for > casting > > to if he needs it. > > We have to be there @ 8:30am... > > i have few questions, why do i have to pay upfront. my insuance will > > pay 80% up to 1000. we were told it was 3,000. for everything so we > > will be out of pocket about 2300. we fig. i am gonna appeal. I have > no > > idea where to start. But i didnt understand why we have to pay or > set > > up payment plan. > > Yall i am getting more and more scared. They cut the internet off at > > work so i can only get on at home which isnt much. > > i do miss reading yall post everyday. any tips. thanks yall > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2006 Report Share Posted January 6, 2006 they did tel me would could work out a payment plan, i was just kinda shocked when she said: do u want to pay the whole 3000. or 2700 or we can work a payment plan. I wasnt expecting it i guess. we have gotten together 1900. so far. Thanks to family and church. So if we have to pay 2300. then we got almost that. I am gonna appeal Ins. sfor sure. i just know dont where to began. > > > > We go monday to dallas to the consult and they made an appt for > casting > > to if he needs it. > > We have to be there @ 8:30am... > > i have few questions, why do i have to pay upfront. my insuance will > > pay 80% up to 1000. we were told it was 3,000. for everything so we > > will be out of pocket about 2300. we fig. i am gonna appeal. I have > no > > idea where to start. But i didnt understand why we have to pay or > set > > up payment plan. > > Yall i am getting more and more scared. They cut the internet off at > > work so i can only get on at home which isnt much. > > i do miss reading yall post everyday. any tips. thanks yall > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2006 Report Share Posted January 6, 2006 they did tel me would could work out a payment plan, i was just kinda shocked when she said: do u want to pay the whole 3000. or 2700 or we can work a payment plan. I wasnt expecting it i guess. we have gotten together 1900. so far. Thanks to family and church. So if we have to pay 2300. then we got almost that. I am gonna appeal Ins. sfor sure. i just know dont where to began. > > > > We go monday to dallas to the consult and they made an appt for > casting > > to if he needs it. > > We have to be there @ 8:30am... > > i have few questions, why do i have to pay upfront. my insuance will > > pay 80% up to 1000. we were told it was 3,000. for everything so we > > will be out of pocket about 2300. we fig. i am gonna appeal. I have > no > > idea where to start. But i didnt understand why we have to pay or > set > > up payment plan. > > Yall i am getting more and more scared. They cut the internet off at > > work so i can only get on at home which isnt much. > > i do miss reading yall post everyday. any tips. thanks yall > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2006 Report Share Posted January 6, 2006 they did tel me would could work out a payment plan, i was just kinda shocked when she said: do u want to pay the whole 3000. or 2700 or we can work a payment plan. I wasnt expecting it i guess. we have gotten together 1900. so far. Thanks to family and church. So if we have to pay 2300. then we got almost that. I am gonna appeal Ins. sfor sure. i just know dont where to began. > > > > We go monday to dallas to the consult and they made an appt for > casting > > to if he needs it. > > We have to be there @ 8:30am... > > i have few questions, why do i have to pay upfront. my insuance will > > pay 80% up to 1000. we were told it was 3,000. for everything so we > > will be out of pocket about 2300. we fig. i am gonna appeal. I have > no > > idea where to start. But i didnt understand why we have to pay or > set > > up payment plan. > > Yall i am getting more and more scared. They cut the internet off at > > work so i can only get on at home which isnt much. > > i do miss reading yall post everyday. any tips. thanks yall > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2006 Report Share Posted January 7, 2006 Check the files for the insurance folder. There is a 1st steps file that can get you started. Then look for an appeal letter in the folder that suits your situation. Copy it and adapt it to your needs! na, 2 1/2, DOC Grad Feb 04 Kiersten, 7 months, DOC 1/10/06, Tort www.thefilyaws.com > > > > > > We go monday to dallas to the consult and they made an appt for > > casting > > > to if he needs it. > > > We have to be there @ 8:30am... > > > i have few questions, why do i have to pay upfront. my insuance > will > > > pay 80% up to 1000. we were told it was 3,000. for everything so > we > > > will be out of pocket about 2300. we fig. i am gonna appeal. I > have > > no > > > idea where to start. But i didnt understand why we have to pay > or > > set > > > up payment plan. > > > Yall i am getting more and more scared. They cut the internet > off at > > > work so i can only get on at home which isnt much. > > > i do miss reading yall post everyday. any tips. thanks yall > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2006 Report Share Posted January 7, 2006 Check the files for the insurance folder. There is a 1st steps file that can get you started. Then look for an appeal letter in the folder that suits your situation. Copy it and adapt it to your needs! na, 2 1/2, DOC Grad Feb 04 Kiersten, 7 months, DOC 1/10/06, Tort www.thefilyaws.com > > > > > > We go monday to dallas to the consult and they made an appt for > > casting > > > to if he needs it. > > > We have to be there @ 8:30am... > > > i have few questions, why do i have to pay upfront. my insuance > will > > > pay 80% up to 1000. we were told it was 3,000. for everything so > we > > > will be out of pocket about 2300. we fig. i am gonna appeal. I > have > > no > > > idea where to start. But i didnt understand why we have to pay > or > > set > > > up payment plan. > > > Yall i am getting more and more scared. They cut the internet > off at > > > work so i can only get on at home which isnt much. > > > i do miss reading yall post everyday. any tips. thanks yall > > > > > > Quote Link to comment Share on other sites More sharing options...
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