Aetna

[Guest guest]

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]

Hey, that's the Cranial Tech we went to!!!! We live in NH, we drove over 3 hours each way to Connecticut. We were very pleased with them (Lynn is a bit more baby personable than ... but they are both VERY good at what they do... and you just have to work at to crack her LOL... nice but not very personable... but she did most of our daughter's adjustments, and castings, and we're pleased). If you need a specialist, you can call them and they will give you the name of a cranial facial doctor at Yale who they work with, who will see your child and write a letter of medical necessity and a prescription for a DOCband (has to say DOCband on the script) if he deems you qualify. Or if you already have a specialist, that's fine too. Cranial Tech will take your child's measurements and they know which ones AETNA requires (diff,. insurances require diff ones). I really respect them because I saw them firsthand turn away people (didn't think their child needed a band at that point), so they don't just band everyone.

I would do it again in a heartbeat... and while some people get banded by orthotic places in NH and Mass that aren't cranial tech and are satisfied with the results and treatment, I had heard too many parents tell me problem stories from the places that Children's Hospital uses in NH and Mass... this area is not really all that band friendly/educated. They tend to only band severe cases around here, in my opinion. So we went to cranial tech hoping for a thorough eval and they gave us their opinion and left the decision to us. They had the most experience of anyone in New England... that's all they do... is band children. So I thought their expertise was worth the 6+ hour drive round trip. The only thing I would have done differently is not let the Mass and NH doctors string me along until my daughter was 9 months. I would have followed my gut and got her banded earlier.

the billing person at that cranial tech office should be able to give you all the pointers she gave me. She was AWESOME. I credit her for the reason we got our pre-cert in 7 days time.

Good luck and let us know how it goes!! You're in good hands )

Colleen

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]

thats how our insurance AVMED was also. We had a developmental pediatrician

write a letter that my daughter had APRAXIA a nuerological condition and needed

feeding therapy because of low tone and the risk of choking. We ended up getting

it covered. You should be able to too.

________________________________

From: sarah marshall <sarah0248@...>

primabullock@...; eileenduffy@...;

Sent: Wed, July 28, 2010 9:07:04 PM

Subject: [ ] Aetna

 

I have Aetna and it is horrible. While they say that they cover " speech

therapy " , the fact is: They don't. They cover it only if it is

rehabilitative (like if there was a stroke)--not habilitative or if there is

some physical anomaly like cleft palate. You can go to www.aetna.com and

look for yourself at their Clinical Policy Bulletin on Speech therapy.

Click on the Individual and Families tab I think it is and there will be a

medium size square kind of in the middle of the page that says Clinical

Policy Bullentins. Click on it and then choose the Medical one (there are 3

and I can't remember what they all are). And then on the following page

there will be a space to type in the number of the bulletin or key words.

Type in " 0243 " (or speech therapy) and their policy will pop up. I have

gone round and round with Aetna trying to pin them down on what they will

cover and no one will tell me except to point me to this bulletin. I have

had more than one speech therapist in my area say, " Oh you have Aetna? They

are notorious for NOT covering speech therapy! " .

I copy and pasted the link--you can try it to see if it will bring you

directly to the bulletin. Otherwise just follow my instructions

http://searchx.aetna.com/_layouts/search/cpb2.aspx?k=0243 & selectedIndex=0 & s=All+\

sources & pt=SDAV%3ahref%2cContains%2chttp%3a%2f%2fwww.aetna.com/cpb/medical/data/\

%2cAnd%2c & wd=+where+%22URL%22+Contains+http%3a%2f%2fwww.aetna.com/cpb/medical/da\

ta/ & RefURL

=

My daugher who turned 2 in June is now receiving services from our school

district and the University (of Minnesota). A friend suggested that I call

the local university's graduate program for speech, hearing and language...I

did and was placed on the waiting list and got in about 3 months later.

They charge $40 per session and do a sliding scale for those that qualify.

My daughter goes twice a week to the University. A graduate student is her

therapist and she is directly supervised for a licensed speech pathologist.

It's a great option for those whose insurance will not cover or those that

do not have insurance.

Good luck!

--

" Birth is not only about making babies. Birth is about making mothers ~

strong, competent, capable mothers who trust themselves and know their inner

strength. "

- Barbara Katz Rothman

[Guest guest]

We have aetna and they are now paying for speech therapy however be aware they

don't reimburse very much. They are paying 40.00 on a 120.00 visit. If you bring

to their attention that they need to follow the new law for kids with an Autism

Spectrum dx they have to start covering these types of therapies (I.e speech,

OT, PT) and apply their reimbursement towards the 36,000 mandated yearly

allowance.

Sent from my iPad