Guest guest Posted June 26, 2003 Report Share Posted June 26, 2003 > , > Insurance carriers do not like to have to deal with the state > Insurance Department so sometimes just asking " do you think it will > help if I write a letter to the Department of Insurance? " may get > a more favorable response. > > Finally, if the hospital can only find one test, how can they bill > for more? Could you use this in negotiating the price if necessary? Dear Kim ...thank you for your kind response, this was exactly what I needed. I have become consumed with this and at this point I don't even think it is about the money, it's principal ( I got a lecture from my husband last night about always being obsessed with something). I don't have a printer hooked up to my laptop here at work but I plan on printing your advice once home tonight ..even if just for moral support. Got to get prepared for that conference call mext week. I am also trying to find out the insurance companies definitions of certain things such as neuropsych testing and austism..there are many areas of exclusion and I think I need an exact definition so I don't find myself in this position once again in the future. So far I have not been able to get this information ...customer service is clueless. I will wait and see how things go next week...the HR person with my company told me that if I did not get anywhere to let him know and he would do the phoning for me after that. Thanks once again and yes I do plan on using the missing tests to negotiate a reduction of my bill..that and the fact that they overcharged the insurance company. Best regards, Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 24, 2009 Report Share Posted February 24, 2009 OUr insurance provider is Blue Cross/Blue Shield and of course we have been denied coverage for our sons helmet. I called and the guy told me it wasn't covered becuase " Wigs, including cranial prostheses are not covered... " . Are the helmets considered cranial prostheses??? I am not surprised that they denied it, and I am going to appeal, but seriously something like this is included with wigs? Robin Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 24, 2009 Report Share Posted February 24, 2009 THAT is weird. I've never heard of them being lumped in with wigs! That has to be wrong. Which state BCBS do you have? Typically, helmets are included under Durable Medical Equipment as a dynamic orthotic cranioplasty. DME includes braces, walkers, cruches, etc. A lot of times it's denied coverage because they don't cover an device that " changes or reshapes a body part. " It's not a cranial prostheses, it's a cranial orthotic, so there has to be something wrong with the way it was coded when submitted to BCBS. Who submitted your claim? I would check to see what code they used on the claim form, that could make a difference. I have BCBS of NC (FEP, so it could be a little different), but the diagnosis I put on the claim was 754.0 (plagiocephaly) and the description of charge code was S1040 (Cranial Remolding Orthosis), and I'm pretty sure those codes are universal, cause I know others have mentioned them before (I think there's also an L1040 or something like it that is a little different). Anyway, I would definitely look into it further, some people have had success working in conjunction with their HR department as well. I just looked in my BCBS brochure and wigs and other cranial prostheses (which aren't covered) fall under Orthopedic and Prosthetic devices, which helmets are not. They are orthotic, not orthopedic. And on the very next page lists DME and under it says, Continuous Passive Motion (CPM) or Dynamic Orthotic Cranioplasty (DOC) devices, so if your brochure is similar, I think it was billed under the wrong code. Hope that helps! Good luck! Jake-2 (DOCBand Grad 9/08) Jordan-5 > > OUr insurance provider is Blue Cross/Blue Shield and of course we have > been denied coverage for our sons helmet. > > I called and the guy told me it wasn't covered becuase " Wigs, > including cranial prostheses are not covered... " . Are the helmets > considered cranial prostheses??? I am not surprised that they denied > it, and I am going to appeal, but seriously something like this is > included with wigs? > > Robin > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 24, 2009 Report Share Posted February 24, 2009 I know that in MD, BCBS automatically denies all cranial orthosis. That's what our specialist said. She has helped with appeals several times and has never seen one successful appeal. It's an exclusion. I know because used to have this coverage and we switched her in September. , mom to , 18 months 14 weeks in STARband plus CST land Re: insurance woes THAT is weird. I've never heard of them being lumped in with wigs! That has to be wrong. Which state BCBS do you have? Typically, helmets are included under Durable Medical Equipment as a dynamic orthotic cranioplasty. DME includes braces, walkers, cruches, etc. A lot of times it's denied coverage because they don't cover an device that "changes or reshapes a body part." It's not a cranial prostheses, it's a cranial orthotic, so there has to be something wrong with the way it was coded when submitted to BCBS. Who submitted your claim? I would check to see what code they used on the claim form, that could make a difference. I have BCBS of NC (FEP, so it could be a little different), but the diagnosis I put on the claim was 754.0 (plagiocephaly) and the description of charge code was S1040 (Cranial Remolding Orthosis), and I'm pretty sure those codes are universal, cause I know others have mentioned them before (I think there's also an L1040 or something like it that is a little different). Anyway, I would definitely look into it further, some people have had success working in conjunction with their HR department as well. I just looked in my BCBS brochure and wigs and other cranial prostheses (which aren't covered) fall under Orthopedic and Prosthetic devices, which helmets are not. They are orthotic, not orthopedic. And on the very next page lists DME and under it says, Continuous Passive Motion (CPM) or Dynamic Orthotic Cranioplasty (DOC) devices, so if your brochure is similar, I think it was billed under the wrong code. Hope that helps!Good luck!Jake-2 (DOCBand Grad 9/08)Jordan-5>> OUr insurance provider is Blue Cross/Blue Shield and of course we have > been denied coverage for our sons helmet. > > I called and the guy told me it wasn't covered becuase "Wigs, > including cranial prostheses are not covered...". Are the helmets > considered cranial prostheses??? I am not surprised that they denied > it, and I am going to appeal, but seriously something like this is > included with wigs? > > Robin> Quote Link to comment Share on other sites More sharing options...
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