Re: Looking for help with purchasing helmet

[Guest guest]

Our insurance company denied any payment of the helmet b/c it stated

that medical devices such as this was not covered under our insurance

plan. When my husband broke his ankle, his cast was covered, but not

my son's helmet. The insuranc company told me after my repeat

appeals that no matter how much documentation is submitted, it will

not be covered even if medically necessary. I really wish they had

told me this before I started the appeal process. I appealed 2 times

with a lot of documentation from all the doctors (pediatrician,

pediatric maxillofacial surgeon, cranial center, etc). In the end,

my husband's benefits department reviewed the claim, appeal and all

the documentation and overturned Blue Cross/Blue Shield's denial of

the helmet and we were told the helmet would be covered in full.

Getting the actual check was like pulling teeth and many phone calls

from myself and the benefits department (thank goodness they were

willing to call on my behalf) b/c we got the run around from the

insurance company about cutting the check (can't be released until my

husband's benefits department needs to send funds, etc). In the end

and 3 months later, the check did come.

My advice...keep appealing and work with the benefits department

where your son receives his insurance. Get behind a really good

benefits rep b/c she's the reason we received payment.

Good luck!

Griffith

Gavin's Mom (wore his helmet for 15 weeks)