Won appeal against Capital Blue Cross in PA!

[Guest guest]

Hello,

For anyone this may help or encourage, we recently won our appeal

against Capital Blue Cross in PA. We were initially denied for the

reason that our son's STARband helmet " wasn't medically necessary. " I

spent over a month writing the letter using the examples posted here

in the files section; and I cc'ed the PA Attorney General, local

senator and representative, and filed a complaint with the PA

Insuranace Department.

Our local senator's and representative's offices were a big help! They

worked together to speed up the review process and had a contact at

CBC. I was so surprised to actually hear from them and it was even

just days after our letter went out. I think we would have won

regardless though ...

In the past Capital Blue Cross approved helmets, but unfortunately

they reversed that stance during the time we had to pay for ours.

Apparently they got a new medical director who stated that they'd no

longer cover helmets. Well that position only lasted a month or so and

now they DO cover helmets (using whatever deductible your specific

plan has.) Our ortho's office was kind enough to give us this inside

scoop, and informed me when CBC began authorizing helmets again just

days after we were denied coverage. So in our appeal letter, I also

had the angle that we didn't feel our son should be discriminated

again. (A little passive aggressive reference to a potential

discrimination lawsuit.)

So remember to cc your local officials. It could help. And ask your

ortho's office if other patients have won appeals or have even been

authorized upon first submission. Every bit of information or support

could help.

Good luck to everyone who's appealing!