Re: How to write appeal letter?

[Guest guest]

Do you happen to have Anthem/Blue Cross. That is what

we have and for Kelsey's FAB with the Markell's, they

will only pay for the bar and not the shoes as well.

It is ludicrous!

I have not appealed this particular situation but my

guess would be that you would need documentation of

the medical necessity of the shoes with probably a

mention that paying for the shoes could avoid much

more costly surgeries in the future.

Jenni

--- Darby wrote:

> With all the talk of getting insurance to pay for

> the mitchells, I

> figured I'd mention my own dilemma...I submitted my

> claim, and out of

> the $382, they're payheing $58. To me it looks

> like they're paying

> for the bar but not the shoes, which is just stupid.

> THey say foot

> orthotics aren't covered unless she's diabetic! SO

> I need to write an

> appeal letter.

>

> But I'm having a really awful day and the thought of

> writing this seems

> daunting. Has anyone written an appeal letter for

> the shoes that was

> approved, and if so, can you show me a copy? What

> medical

> documentation did you include?

>

> Darby

> Livi 3.15.04 bi cf

> p/m fab 16/7

>

>

>

Jenni-

Mom to (10/31/01) and Kelsey (11/7/03)happy girl in DBB nights only for

left clubfoot.

____________________________________________________

Start your day with Yahoo! - make it your home page

http://www.yahoo.com/r/hs

[Guest guest]

Jenni,

You should appeal this. And it has been done successfully in many situations.

When a Dr. makes the point that they prescribed only the shoes to save the

insurance co money and if need be he'll prescribe a new bar each time as well it

seems they get smart and cover the shoes. Try it. You will be thrilled with

the outcome! LOL

Chris

Re: How to write appeal letter?

Do you happen to have Anthem/Blue Cross. That is what

we have and for Kelsey's FAB with the Markell's, they

will only pay for the bar and not the shoes as well.

It is ludicrous!

I have not appealed this particular situation but my

guess would be that you would need documentation of

the medical necessity of the shoes with probably a

mention that paying for the shoes could avoid much

more costly surgeries in the future.

Jenni

--- Darby wrote:

> With all the talk of getting insurance to pay for

> the mitchells, I

> figured I'd mention my own dilemma...I submitted my

> claim, and out of

> the $382, they're payheing $58. To me it looks

> like they're paying

> for the bar but not the shoes, which is just stupid.

> THey say foot

> orthotics aren't covered unless she's diabetic! SO

> I need to write an

> appeal letter.

>

> But I'm having a really awful day and the thought of

> writing this seems

> daunting. Has anyone written an appeal letter for

> the shoes that was

> approved, and if so, can you show me a copy? What

> medical

> documentation did you include?

>

> Darby

> Livi 3.15.04 bi cf

> p/m fab 16/7

>

>

>

Jenni-

Mom to (10/31/01) and Kelsey (11/7/03)happy girl in DBB nights only for

left clubfoot.

____________________________________________________

Start your day with Yahoo! - make it your home page

http://www.yahoo.com/r/hs

[Guest guest]

I may appeal it the next time we need shoes. We paid

for the 1st ones because quite frankly, at the time, I

just did not have the energy to fight it because of

other issues with Kelsey. Then, when we needed our

second pair, Kori generously passed on a pair of

Darby's so we were saved that expense. Also, the new

orthotic place that we go to in Cincinnati, the

orthotist there told us that they take old shoes from

parents and will pass them on to us clubfoot parents

for free if they have the size that we need when we

need them. All in all, with the insurance, we have

been pretty fortunate in that we have had to pay for

very little of other things so even if we have to pay

for an occasional pair of Markell's. it is really not

that bad to deal with. If we were wearing

shoes, it would be a different story because of the

cost.

Jenni

--- wrote:

> Jenni,

> You should appeal this. And it has been done

> successfully in many situations. When a Dr. makes

> the point that they prescribed only the shoes to

> save the insurance co money and if need be he'll

> prescribe a new bar each time as well it seems they

> get smart and cover the shoes. Try it. You will

> be thrilled with the outcome! LOL

> Chris

>

> Re: How to write

> appeal letter?

>

>

> Do you happen to have Anthem/Blue Cross. That is

> what

> we have and for Kelsey's FAB with the Markell's,

> they

> will only pay for the bar and not the shoes as

> well.

> It is ludicrous!

> I have not appealed this particular situation but

> my

> guess would be that you would need documentation

> of

> the medical necessity of the shoes with probably a

> mention that paying for the shoes could avoid much

> more costly surgeries in the future.

>

> Jenni

>

>

> --- Darby wrote:

>

> > With all the talk of getting insurance to pay

> for

> > the mitchells, I

> > figured I'd mention my own dilemma...I submitted

> my

> > claim, and out of

> > the $382, they're payheing $58. To me it looks

> > like they're paying

> > for the bar but not the shoes, which is just

> stupid.

> > THey say foot

> > orthotics aren't covered unless she's diabetic!

> SO

> > I need to write an

> > appeal letter.

> >

> > But I'm having a really awful day and the

> thought of

> > writing this seems

> > daunting. Has anyone written an appeal letter

> for

> > the shoes that was

> > approved, and if so, can you show me a copy?

> What

> > medical

> > documentation did you include?

> >

> > Darby

> > Livi 3.15.04 bi cf

> > p/m fab 16/7

> >

> >

> >

>

>

> Jenni-

> Mom to (10/31/01) and Kelsey (11/7/03)happy

> girl in DBB nights only for left clubfoot.

>

>

>

>

> ____________________________________________________

> Start your day with Yahoo! - make it your home

> page

> http://www.yahoo.com/r/hs

>

>

>

>

[Guest guest]

We have Aetna - and they pay in full for the Markells, just not the

s (yet). I just wonder how much medical documentation they

need. DO I have to write a 5 page " book report " on the ponseti

method and club foot treatment? Or am I making this more difficult

than it needs to be?

Darby

>

> > With all the talk of getting insurance to pay for

> > the mitchells, I

> > figured I'd mention my own dilemma...I submitted my

> > claim, and out of

> > the $382, they're payheing $58. To me it looks

> > like they're paying

> > for the bar but not the shoes, which is just stupid.

> > THey say foot

> > orthotics aren't covered unless she's diabetic! SO

> > I need to write an

> > appeal letter.

> >

> > But I'm having a really awful day and the thought of

> > writing this seems

> > daunting. Has anyone written an appeal letter for

> > the shoes that was

> > approved, and if so, can you show me a copy? What

> > medical

> > documentation did you include?

> >

> > Darby

> > Livi 3.15.04 bi cf

> > p/m fab 16/7

> >

> >

> >

>

>

> Jenni-

> Mom to (10/31/01) and Kelsey (11/7/03)happy girl in DBB

nights only for left clubfoot.

>

>

>

> ____________________________________________________

> Start your day with Yahoo! - make it your home page

> http://www.yahoo.com/r/hs

[Guest guest]

Hi,

I don't know if this will be helpful to you...our experience was

with Aetna in NY City, in August 2000. They initially refused to

pay for the shoes, altho' they would pay for the bar, but I learned

that they had classified the shoes as " orthotics " when in fact they

are " durable medical equipment. " I didn't have to do the formal

appeal, altho' I was at first told that I would need to do that. I

just telephoned their appeals office and discussed it with a woman

there, and the medical equipment place that was making the DBB for

us had given me the model number, etc., for the shoes to show that

they were not orthotics. Also, Dr. Feldman wrote us a letter to

send along to Aetna, briefly describing the situation. In the end,

they paid. Don't give up; we all pay too much for insurance to let

them get away with things like this! Pam Karydas (mom to Dinos, bi-

lateral clubfoot, June 2000, treated by Drs. Feldman and Ponseti.)

> >

> > > With all the talk of getting insurance to pay for

> > > the mitchells, I

> > > figured I'd mention my own dilemma...I submitted my

> > > claim, and out of

> > > the $382, they're payheing $58. To me it looks

> > > like they're paying

> > > for the bar but not the shoes, which is just stupid.

> > > THey say foot

> > > orthotics aren't covered unless she's diabetic! SO

> > > I need to write an

> > > appeal letter.

> > >

> > > But I'm having a really awful day and the thought of

> > > writing this seems

> > > daunting. Has anyone written an appeal letter for

> > > the shoes that was

> > > approved, and if so, can you show me a copy? What

> > > medical

> > > documentation did you include?

> > >

> > > Darby

> > > Livi 3.15.04 bi cf

> > > p/m fab 16/7

> > >

> > >

> > >

> >

> >

> > Jenni-

> > Mom to (10/31/01) and Kelsey (11/7/03)happy girl in DBB

> nights only for left clubfoot.

> >

> >

> >

> > ____________________________________________________

> > Start your day with Yahoo! - make it your home page

> > http://www.yahoo.com/r/hs

[Guest guest]

When I wrote my appeal for a different issue, I did

not provide a book but I pointed out parts of my

coverage that showed that we should have been covered.

I was also specific about people spoken to etc. I

think a simple letter of medical necessity should work

perhaps with a description and/or picture of the brace

showing that it is indeed a brace and not just a pair

of orthopedic shoes.

Jenni

--- Darby wrote:

> We have Aetna - and they pay in full for the

> Markells, just not the

> s (yet). I just wonder how much medical

> documentation they

> need. DO I have to write a 5 page " book report " on

> the ponseti

> method and club foot treatment? Or am I making this

> more difficult

> than it needs to be?

>

> Darby

>

> >

> > > With all the talk of getting insurance to pay

> for

> > > the mitchells, I

> > > figured I'd mention my own dilemma...I submitted

> my

> > > claim, and out of

> > > the $382, they're payheing $58. To me it looks

> > > like they're paying

> > > for the bar but not the shoes, which is just

> stupid.

> > > THey say foot

> > > orthotics aren't covered unless she's diabetic!

> SO

> > > I need to write an

> > > appeal letter.

> > >

> > > But I'm having a really awful day and the

> thought of

> > > writing this seems

> > > daunting. Has anyone written an appeal letter

> for

> > > the shoes that was

> > > approved, and if so, can you show me a copy?

> What

> > > medical

> > > documentation did you include?

> > >

> > > Darby

> > > Livi 3.15.04 bi cf

> > > p/m fab 16/7

> > >

> > >

> > >

> >

> >

> > Jenni-

> > Mom to (10/31/01) and Kelsey (11/7/03)happy

> girl in DBB

> nights only for left clubfoot.

> >

> >

> >

> >

> ____________________________________________________

> > Start your day with Yahoo! - make it your home

> page

> > http://www.yahoo.com/r/hs

>

>

>

Jenni-

Mom to (10/31/01) and Kelsey (11/7/03)happy girl in DBB nights only for

left clubfoot.

__________________________________________________