Guest guest Posted February 14, 2008 Report Share Posted February 14, 2008 I have BCBS of CA and live in WA. They paid for my daughter's helmet. When you live out-of-state, you are supposed to file with the local BCBS office. That being said, I've never filed a claim. I've always been able to have the doc's office do it. Good luck, Seattle area daughter 9 months in Hangar helmet Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 15, 2008 Report Share Posted February 15, 2008 Hi - thanks for the info... I found from Blue Cross of CA yesterday that it's totally under the digression of Cranial Tech whether they want to file it in-network (since I have BCBS of CA and it's in-network there) or out-of-network (since the service was rendered in NC). They chose to file out-of-network to make the additional $1200.00 (since it's only $2100 in CA with the member discount, opposed to the $3300 it is up front). I'm very happy with the improvement in my son's head, but very unhappy with their decision not to help us out and file out-of-network. My son needs a second helmet for further correction per CT, but I'm not certain it is financially possible. -----Original Message-----From: Plagiocephaly [mailto:Plagiocephaly ]On Behalf Of Sent: Thursday, February 14, 2008 10:06 PMPlagiocephaly Subject: Re: BCBS of CA I have BCBS of CA and live in WA. They paid for my daughter's helmet.When you live out-of-state, you are supposed to file with the localBCBS office. That being said, I've never filed a claim. I've alwaysbeen able to have the doc's office do it. Good luck,Seattle areadaughter 9 months in Hangar helmet Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 15, 2008 Report Share Posted February 15, 2008 if she had filed with local BC it would have been denied though BCBS SC denies bands regularly even after they lost the lawsuit 2 years ago. Or at least thats what the orthotist at Hanger (in network for BCBS SC whereas CT is not) said and the 2 ppl I know who have BCBS SC. Sounds like she is in a catch 22 here. Have you tried your companies HR sometimes they get better results talking to insurance as it sounds like you need a way to get insurance and CT talking to find out what issue it really is On Thu, Feb 14, 2008 at 10:06 PM, <kmfoster@...> wrote: I have BCBS of CA and live in WA. They paid for my daughter's helmet.When you live out-of-state, you are supposed to file with the localBCBS office. That being said, I've never filed a claim. I've always been able to have the doc's office do it. Good luck,Seattle areadaughter 9 months in Hangar helmet -- SC SAHM to , , and " A large family " , the Pope remarked, " constitutes a witness of faith, courage, and optimism. " Moreover, large families provide wealth to society, " because without children there is no future! " Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 15, 2008 Report Share Posted February 15, 2008 wow, I had heard the price was going up but that is a huge jump, we just got ours in august of last year so only 6 mo ago and ours was $2700 up front which could be why CT has an issue there, if there prices went up $600 and their contract with BC was signed back when it was only $2700 up front it was only a $600 discount which doesnt seem near as much as a $1200 discount. Though IMHO $600 JUMP in price is HUGE, I can see prices going up but I wonder how they justify a $600 single increase as without a justification it sounds liek price gouging b/c plagio incidence is going up so their need is going up and they are the only company that does it in some cases, in others they may be the only competant option, like a monopoly almost. Mind yuo I wouldnt think it so bad if their original price wasnt so low copared to teh new price b/c when I calculated it out I figured that $1000 for the band wasnt bad considering how much a prosthetic costs and so I divided the remaining $1700 amoung our approx 12 visits over the 3 mo and it only came out to $140 a visit which fro a specialist visit seemed fairly average. The new cost though seems too high On Fri, Feb 15, 2008 at 7:03 AM, Staci Hyde <shyde@...> wrote: Hi - thanks for the info... I found from Blue Cross of CA yesterday that it's totally under the digression of Cranial Tech whether they want to file it in-network (since I have BCBS of CA and it's in-network there) or out-of-network (since the service was rendered in NC). They chose to file out-of-network to make the additional $1200.00 (since it's only $2100 in CA with the member discount, opposed to the $3300 it is up front). I'm very happy with the improvement in my son's head, but very unhappy with their decision not to help us out and file out-of-network. My son needs a second helmet for further correction per CT, but I'm not certain it is financially possible. Re: BCBS of CA I have BCBS of CA and live in WA. They paid for my daughter's helmet.When you live out-of-state, you are supposed to file with the localBCBS office. That being said, I've never filed a claim. I've always been able to have the doc's office do it. Good luck,Seattle areadaughter 9 months in Hangar helmet -- SC SAHM to , , and " A large family " , the Pope remarked, " constitutes a witness of faith, courage, and optimism. " Moreover, large families provide wealth to society, " because without children there is no future! " Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 15, 2008 Report Share Posted February 15, 2008 It is 3300 and 3000 if you pay in one lump sum. I apologize...the way I explained it was confusing! The increase was 300. Re: BCBS of CA I have BCBS of CA and live in WA. They paid for my daughter's helmet.When you live out-of-state, you are supposed to file with the localBCBS office. That being said, I've never filed a claim. I've alwaysbeen able to have the doc's office do it. Good luck,Seattle areadaughter 9 months in Hangar helmet -- SC SAHM to , , and "A large family", the Pope remarked, "constitutes a witness of faith, courage, and optimism." Moreover, large families provide wealth to society, "because without children there is no future!" Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 15, 2008 Report Share Posted February 15, 2008 ok $300 is better, anyone know how often they raise it? jc b/c it sounds reasonable but guess it depends on how often they raise like my electric rate was raised 2 yrs ago a lot but they rarely raise it whereas my cable bill goes up every yr, a dollar, maybe even 2 every year seems reasonable for an annual raise but this year it went up $5 after $3 last year which to me is no longer reasonable (especially since their cs stinks). so anyway was just curious since it can all be relative On Fri, Feb 15, 2008 at 8:24 AM, Staci Hyde <shyde@...> wrote: It is 3300 and 3000 if you pay in one lump sum. I apologize...the way I explained it was confusing! The increase was 300. Re: BCBS of CA I have BCBS of CA and live in WA. They paid for my daughter's helmet.When you live out-of-state, you are supposed to file with the localBCBS office. That being said, I've never filed a claim. I've always been able to have the doc's office do it. Good luck,Seattle areadaughter 9 months in Hangar helmet -- SC SAHM to , , and " A large family " , the Pope remarked, " constitutes a witness of faith, courage, and optimism. " Moreover, large families provide wealth to society, " because without children there is no future! " -- SC SAHM to , , and " A large family " , the Pope remarked, " constitutes a witness of faith, courage, and optimism. " Moreover, large families provide wealth to society, " because without children there is no future! " Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 15, 2008 Report Share Posted February 15, 2008 not sure how often...i would imagine you're right, every 2 years or so. i'm not certain, but couldn't the provider negotiate the contracted amount with the insurance company every time the contract period ends because of rising healthcare costs, etc? just a thought. anyway, i am very happy with my son's head and our clinician, but feel if corporate has the option to file in-network for one of their clients, they should. bsbc of ca said the majority of the time, in this type of situation, they do. Re: BCBS of CA I have BCBS of CA and live in WA. They paid for my daughter's helmet.When you live out-of-state, you are supposed to file with the localBCBS office. That being said, I've never filed a claim. I've alwaysbeen able to have the doc's office do it. Good luck,Seattle areadaughter 9 months in Hangar helmet -- SC SAHM to , , and "A large family", the Pope remarked, "constitutes a witness of faith, courage, and optimism." Moreover, large families provide wealth to society, "because without children there is no future!" -- SC SAHM to , , and "A large family", the Pope remarked, "constitutes a witness of faith, courage, and optimism." Moreover, large families provide wealth to society, "because without children there is no future!" Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 15, 2008 Report Share Posted February 15, 2008 Have you had further discussion with CT? That is really too bad - I hope they are willing to work with you. :-( Jen and Luli - 26 months Left tort - Right Plagio - Hanger Band Grad - CA http://www.babiesonline.com/babies/j/jens5th/ Re: BCBS of CA I have BCBS of CA and live in WA. They paid for my daughter's helmet. When you live out-of-state, you are supposed to file with the local BCBS office. That being said, I've never filed a claim. I've always been able to have the doc's office do it. Good luck, Seattle area daughter 9 months in Hangar helmet More new features than ever. Check out the new AOL Mail! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 15, 2008 Report Share Posted February 15, 2008 Yes, I discussed with the national insurance/billing supervisor and she they absolutely will not do in-network. She said they can't afford to give everyone in the country the in-network rate. Needless to say, it wasn't the most pleasant conversation. They are recommending a second band, but honestly I don't think we can do it. It's very frustrating. But, he has come a long way with the first band (20 mm of asymmetry for plagio and mild brachy to completely corrected brachy and 9 mm asymmetry for plagio). We are very thankful for this degree of improvement. RE: Re: BCBS of CA Hi - thanks for the info... I found from Blue Cross of CA yesterday that it's totally under the digression of Cranial Tech whether they want to file it in-network (since I have BCBS of CA and it's in-network there) or out-of-network (since the service was rendered in NC). They chose to file out-of-network to make the additional $1200.00 (since it's only $2100 in CA with the member discount, opposed to the $3300 it is up front). I'm very happy with the improvement in my son's head, but very unhappy with their decision not to help us out and file out-of-network. My son needs a second helmet for further correction per CT, but I'm not certain it is financially possible. -----Original Message-----From: Plagiocephaly [mailto:Plagiocephaly ]On Behalf Of Sent: Thursday, February 14, 2008 10:06 PMPlagiocephaly Subject: Re: BCBS of CA I have BCBS of CA and live in WA. They paid for my daughter's helmet.When you live out-of-state, you are supposed to file with the localBCBS office. That being said, I've never filed a claim. I've alwaysbeen able to have the doc's office do it. Good luck,Seattle areadaughter 9 months in Hangar helmet More new features than ever. Check out the new AOL Mail! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 15, 2008 Report Share Posted February 15, 2008 have you contacted corporate ct? On Fri, Feb 15, 2008 at 9:44 AM, Staci Hyde <shyde@...> wrote: not sure how often...i would imagine you're right, every 2 years or so. i'm not certain, but couldn't the provider negotiate the contracted amount with the insurance company every time the contract period ends because of rising healthcare costs, etc? just a thought. anyway, i am very happy with my son's head and our clinician, but feel if corporate has the option to file in-network for one of their clients, they should. bsbc of ca said the majority of the time, in this type of situation, they do. Re: BCBS of CA I have BCBS of CA and live in WA. They paid for my daughter's helmet.When you live out-of-state, you are supposed to file with the localBCBS office. That being said, I've never filed a claim. I've always been able to have the doc's office do it. Good luck,Seattle areadaughter 9 months in Hangar helmet -- SC SAHM to , , and " A large family " , the Pope remarked, " constitutes a witness of faith, courage, and optimism. " Moreover, large families provide wealth to society, " because without children there is no future! " -- SC SAHM to , , and " A large family " , the Pope remarked, " constitutes a witness of faith, courage, and optimism. " Moreover, large families provide wealth to society, " because without children there is no future! " -- SC SAHM to , , and " A large family " , the Pope remarked, " constitutes a witness of faith, courage, and optimism. " Moreover, large families provide wealth to society, " because without children there is no future! " Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 15, 2008 Report Share Posted February 15, 2008 and i am sure when you realised you were not going to ever get anyhere you oh so nicely told her then they shouldnt have signed the contract, isnt it against their bcbs contract to overcharge the pt, what did bc say about that? i probably would have also (but i am in a ticky mood) told them that everything that is happening is not looking so kindly to the large internet group on plagiocephaly that you are keeping updated on the situation On Fri, Feb 15, 2008 at 12:17 PM, Staci Hyde <shyde@...> wrote: Yes, I discussed with the national insurance/billing supervisor and she they absolutely will not do in-network. She said they can't afford to give everyone in the country the in-network rate. Needless to say, it wasn't the most pleasant conversation. They are recommending a second band, but honestly I don't think we can do it. It's very frustrating. But, he has come a long way with the first band (20 mm of asymmetry for plagio and mild brachy to completely corrected brachy and 9 mm asymmetry for plagio). We are very thankful for this degree of improvement. RE: Re: BCBS of CA Hi - thanks for the info... I found from Blue Cross of CA yesterday that it's totally under the digression of Cranial Tech whether they want to file it in-network (since I have BCBS of CA and it's in-network there) or out-of-network (since the service was rendered in NC). They chose to file out-of-network to make the additional $1200.00 (since it's only $2100 in CA with the member discount, opposed to the $3300 it is up front). I'm very happy with the improvement in my son's head, but very unhappy with their decision not to help us out and file out-of-network. My son needs a second helmet for further correction per CT, but I'm not certain it is financially possible. -----Original Message-----From: Plagiocephaly [mailto:Plagiocephaly ]On Behalf Of Sent: Thursday, February 14, 2008 10:06 PMPlagiocephaly Subject: Re: BCBS of CA I have BCBS of CA and live in WA. They paid for my daughter's helmet.When you live out-of-state, you are supposed to file with the localBCBS office. That being said, I've never filed a claim. I've always been able to have the doc's office do it. Good luck,Seattle areadaughter 9 months in Hangar helmet More new features than ever. Check out the new AOL Mail! -- SC SAHM to , , and " A large family " , the Pope remarked, " constitutes a witness of faith, courage, and optimism. " Moreover, large families provide wealth to society, " because without children there is no future! " Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 15, 2008 Report Share Posted February 15, 2008 the contact that i dealt with is with corporate Re: BCBS of CA I have BCBS of CA and live in WA. They paid for my daughter's helmet.When you live out-of-state, you are supposed to file with the localBCBS office. That being said, I've never filed a claim. I've alwaysbeen able to have the doc's office do it. Good luck,Seattle areadaughter 9 months in Hangar helmet -- SC SAHM to , , and "A large family", the Pope remarked, "constitutes a witness of faith, courage, and optimism." Moreover, large families provide wealth to society, "because without children there is no future!" -- SC SAHM to , , and "A large family", the Pope remarked, "constitutes a witness of faith, courage, and optimism." Moreover, large families provide wealth to society, "because without children there is no future!" -- SC SAHM to , , and "A large family", the Pope remarked, "constitutes a witness of faith, courage, and optimism." Moreover, large families provide wealth to society, "because without children there is no future!" Quote Link to comment Share on other sites More sharing options...
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