Re: How long before Aetna makes determination?

[Guest guest]

Hi Carmen,

I also have a Hanger helmet and Aetna insurance. Aetna covered the

helmet in full. I have Aetna Aexcel Plus (PPO) plan. If you have this

plan I do not see why they would not cover it.

Did you also get a letter of medical necessity from whoever referred

you to Hangar for the helmet?

Hanger is supposed to submit this letter to the ins. co.

Let me know!

>

> Well the braniacs at Hanger filed claims with Aetna for my twins

> helmets last week (after telling us they had done so back in

August).

> Well I noticed today that the claim was in their (Aetna)system

> saying " Additional info required. " So I emailed them and this is

what

> they had to say:

>

> This claim was received on October 13, 2006. It normally takes 10-

15

> business days for claims to be finalized. However, because of the

> type

> of durable medical equipment this is, it will take longer to

> determine

> if it is a coverable expense for your plan. Equipment like this

> should

> be precertified prior to purchasing to determine if the equipment is

> covered.

>

> I was never told it had to get anything pre-certified. All I know

was

> that the woman from Hanger called Aetna and they simply told her

that

> it was considered cosmetic and would not be covered.

> When I called Aetna a couple of weeks ago, they told me that

helmets

> WOULD be covered as long as we had all documentation and that twins

> met criteria with measurements (which they do).

>

> So I guess I'll just have to sit back and hope for the best. Any

> experiences with Aetna? Did they cover your helmets?

>

> Carmen

>

[Guest guest]

I urge you not to sit back and wait to see what happens, but start

putting together your war chest of supporting documentation that

your child's helmet is a medical necessity, not a cosmetic thing.

My husband and I have been through 3 appeals and the final one seems

to be the charm, but we collected supporting docs from every person

we met wtih (pediatrician, specialist pediatric plastic surgeon,

orthotist, etc.), got a copy of the policy stating what they cover,

and included over 10 papers written about the efficacy of cranial

remolding devices. We realized at some point that it is in the

insurance company's interest to keep denying until you fight them on

it - why not? But when they see that in several states other

insurance companies have been sued successfully by states' attorneys

and that other insurance companies cover helmets in their policies

now...They will hopefully cave in and reimburse you. It will take

some getting organized, but will be well worth the $$ to show them

you are not going to settle for $0 for your little one's treatment!

Good luck,

Stacia

mom to Drew (tort, plagio, 9 mos. old, in STARband 3 weeks now)

Chicago, IL

>

> Well the braniacs at Hanger filed claims with Aetna for my twins

> helmets last week (after telling us they had done so back in

August).

> Well I noticed today that the claim was in their (Aetna)system

> saying " Additional info required. " So I emailed them and this is

what

> they had to say:

>

> This claim was received on October 13, 2006. It normally takes 10-

15

> business days for claims to be finalized. However, because of the

> type

> of durable medical equipment this is, it will take longer to

> determine

> if it is a coverable expense for your plan. Equipment like this

> should

> be precertified prior to purchasing to determine if the equipment

is

> covered.

>

> I was never told it had to get anything pre-certified. All I know

was

> that the woman from Hanger called Aetna and they simply told her

that

> it was considered cosmetic and would not be covered.

> When I called Aetna a couple of weeks ago, they told me that

helmets

> WOULD be covered as long as we had all documentation and that

twins

> met criteria with measurements (which they do).

>

> So I guess I'll just have to sit back and hope for the best. Any

> experiences with Aetna? Did they cover your helmets?

>

> Carmen

>

[Guest guest]

Hi Everyone I am responding to Carmen's message about AETNA. My husband and I recently had to change insurance carriers following the birth our our son (tortocollis and plagiocephaly dx at 2 months, DOC band at 4months) and changes in our employment. Aetna was one of the insurance carriers we could have chosen so we did exhaustive research on their policies on what they term "cranial remolding bands/helmets" We came across their policy on bands which was last updated this past spring. As we found the info online, I will list the link here so you can look at it for yourself. http://www.aetna.com/cpb/data/CPBA0379.html I also discussed AETNA with cranial technologies. Here is what I was told. Aetna considers CT to be in network so in network benefits apply. AETNA will not band unless your child is between 4 and 12 months old. You must have a

note from your doctor saying that you have done a certain amount of repositioning. The plagiocephaly must be modrate to severe and meet the measurement requirements. I hope you are able to access the documentation from AETNA and it is helpful to you in getting results sooner. Kathleen

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