Re: 's Story and beginning the insurance battle

[Guest guest]

In a message dated 1/3/01 12:37:19 PM Pacific Standard Time, VHBC@... writes:

They have been helpful so far but Coventry has been dragging there feet. Cranial Tech told them that Coventry has never paid for a band.

Wow, so glade to hear the heart surgery went well. Scary!

Again, don't think you have to have the DOC Band. Look into the STAR Band or your local helmet maker. Let us know where you are located. Maybe someone in your area has experience with someone other than the DOC Band. There are products that look and do the same thing. Just make sure you are happy with the orthotics person. I don't have to do the math for you to even think about the cost of 2-3 bands. If you go with another products, 2-3 could be the price of one DOC Band.

We did the DOC Band in June & July at $2,500 in Wisconsin. We seem to have the best deal around here. We got minimal results and did craniosacral from August and on. We opted for a STAR Band to give things a try again. We've been in our band since the end of November and have seen some nice changes. We will never have the "perfect head" but had to do all that I could.

I think back and in April and May last year, I said I have to have this DOC Band it is the best. Well, with the FDA thing going on that is all I really could get. I'm one of the few who don't give our 7 1/2 weeks in the DOC Band rave reviews. So please, consider someone local if can and save yourself a lot of money.

Tammy & 12/8/99

[Guest guest]

We are ready to fight to have our sons head nice and round and if the

insurance company doesn't pay I told Robin, my wife, I was ready to

eat cold bologna and cheese sandwiches to see my son's head a normal

shape.

What a great Daddy!

Make sure you check the files section for some excellent SUCCESSFUL

appeals letters. I don't have any personal experience with fighting

insurance, but I'm sure someone will jump in with some help. Be persistent.

Good luck!

Kendra

VHBC@... wrote:

My wife and I had our first son in July and immediately

we knew there

were problems with 's head. Everytime we mentioned

it to

someone they just told us it would correct itself and not to worry.

Needless to say it never did correct itself. The problem

was

compounded when our son was diagnosed with a congenital heart

defect. He would go on to spend the first three weeks in

the

hospital and close monitoring until since then. He has heart

surgery

on 12/27/00 and is doing fine. All this time we were so worried

about his heart that the head issue came up infrequently.

's

cardiologist was the first to refer us to a neurosurgeon.

He works

closely with the local cranial tech office. They have been

helpful

so far but Coventry has been dragging there feet. Cranial

Tech told

them that Coventry has never paid for a band.

The bad part is that before we even start with the mold or go any

further we must be turned down by the insurance company.

We were

told that our son's head was so misshapen that he was not even

on the

charts for how much he deviated. We kinda already knew that

but when

they told us that to get a good shape he would need two or three

bands we were floored. I know I have read several of you

folks

stories and it breaks my heart to hear them but if anyone can help

me

and encourage my wife and I we sure would appreciate it.

We are ready to fight to have our sons head nice and round and

if the

insurance company doesn't pay I told Robin, my wife, I was ready

to

eat cold bologna and cheese sandwiches to see my son's head a normal

shape.

[Guest guest]

Fight to the finish! Phone calls, phone calls, phone calls - bug 'em to

death!! If your insurance company denies you the first time get right back in

there and start along the appeals track. Do you have an HMO or a PPO? If the

appeals does not work then you could and should file a complaint with the

Department of Insurance and/or the State Department of Health (you can find

information and complaint forms online) Then - if that doesn't work then you

can consult with an attorney (usually for free the first time) and decide

where to go from there. Also, consider writing letters to your state and

federal legislative people and the governor of your state. Everytime you

complete another step make sure you send a copy to your insurance company so

they know that you mean business. Document everything. I have an " events log "

in which I keep dates, times, names of people, phone numbers, appointments -

absolutely everything!! Check in the files section of this egroup for a

section on inusurance help. Read your policy carefully and see where they

stand on Durable Medical Equipment (DME) - if you have coverage for that then

go at the insurance company from that angle. Get as many letters from your

doctors (neuro, ped and anyone else who will help) as you can detailing why

the treatment is medically necessary - this way the insurance company has a

harder time trying to deny you based on thier opinion that the treatment is

cosmetic. You guys are doing great things for - he is SOOO lucky to

have a mommy and daddy who care enough to go all the way. (or at least eat

bologna and cheese indefinately! *grin*) You will get through this with

flying colors because you are united and have a common goal - getting

healthy! Keep that as your focus and don't let anyone stand in your way!! One

final note - I would consider contacting your local TV stations and see if

they would like to do a piece on your story if your comfortable with that

much exposure. The squeaky wheel does get the oil - so speak your mind long

and loud and clear to anyone and everyone who might be able to help -

persistence!!

Good luck to you and your wife and to - he sounds like one tough

cookie!! Please keep us posted - I would very much like to hear what happens.

Marci