Guest guest Posted January 3, 2001 Report Share Posted January 3, 2001 Meagan, We have CIGNA International and they covered my daughters helmet 80% without any problems. All they asked for was a letter of Medical Necessity. I don't know if the international plan and the regular CIGNA plan have the same views regarding Plagio though. If they don't, they should! Good luck with your appeals! If this message posts twice, sorry! My server messed up in the middle of sending this! Andreya and Taryn S. Korea --- In Plagiocephalyegroups, " Meagan Palmer " <mpalmer@c...> wrote: > I'm new to this e-mail group. Hopefully I'll do this right the first time. > > My 9 month old daughter getting fitted for her second band next week. The Wellness Plan did not cover the first band and we are on the second level of appeal. I am also meeting with an attorney tomorrow to discuss other options. We have switched to CIGNA this year and it is my understanding that they will not cover either. Has anyone had any luck with these two insurance companies? Does anyone have any suggestions regarding legal action? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 4, 2001 Report Share Posted January 4, 2001 --- In Plagiocephalyegroups, " Meagan Palmer " <mpalmer@c...> wrote: > Hey Angie, > > I wasn't very encouraged today after my meeting with the attorney. He did find a " loophole " to argue in the second appeal but it has to do with the contractual agreement in the Membership Certificate as opposed to the medical necessity argument we originally argued. Basically, he would charge around $500 to write a letter on our behalf prior to the 2nd appeal hearing. It would cost between $1000 - $1500 for him to represent us at that hearing. Of course, no guarantees and there would be no consequences even if Wellness acknowledged the validity of his argument but still upheld their decision to deny the claim. If we were to take this to court, it could cost up to $10,000! > > I would love to talk with you more about this. How can I contact you? Are we allowed to leave phone numbers or addresses via e-mail? I live in Charlotte as well. > > Looking forward to hearing from you, > Meagan Palmer > ----- Original Message ----- > From: Angie Pope > Plagiocephalyegroups > Sent: Wednesday, January 03, 2001 8:33 AM > Subject: Re: Insurance coverage > > > I am also on my second appeal to the Wellness Plan.(I live in Charlotte NC) I was told two weeks ago (At Cranial technologies) that Wellness approved payment of a band! (this happened in December - so there is hope!) I have researched and written up a plethera of information to Wellness. I will not give up! By the way - if you have a good attorney, please forward his name and telephone!!! Hang in there! > Angie Pope > > Sales Representative, Pac-Van Leasing & Sales > ----- Original Message ----- > From: Meagan Palmer > CT > Sent: Sunday, December 31, 2000 2:31 AM > Subject: Insurance coverage > > > I just wanted to let you folks know that my wife and I along with our son live in the Charlotte area. That would be Bessemer City and wanted to know how the Cranial Tech really was in Charlotte. I just posted my sons story to('s story and beginning...) We are wanting to get started but the insurance company has us at a stand still. We look forward to hearing from you. , Robin and I'm new to this e-mail group. Hopefully I'll do this right the first time. > > My 9 month old daughter getting fitted for her second band next week. The Wellness Plan did not cover the first band and we are on the second level of appeal. I am also meeting with an attorney tomorrow to discuss other options. We have switched to CIGNA this year and it is my understanding that they will not cover either. Has anyone had any luck with these two insurance companies? Does anyone have any suggestions regarding legal action? > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 17, 2010 Report Share Posted February 17, 2010 Teri, Welcome to the group Genetech has a Xolair debit card to help us with our deductibles. Call 1-877-411-8641. This helped me a LOT! Doug Group founder on Xolair for 6+ years Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 17, 2010 Report Share Posted February 17, 2010 Hey Teri, I have my insurance thru Antares. I get full payment, but I think that is because my employer pays all expenses. I work for a large hospital (Cleveland Clinic) and they are empathetic to my needs. Good luck with your search. Mark From: tericcrawford <tericcrawford@...> Subject: [ ] Insurance Coverage Date: Wednesday, February 17, 2010, 11:51 AM I'm new to this group. But I have been taking Xolair for several years now with great results. I have Blue Cross / Blue Shield of Oklahoma. My copay is $1000.00 per month. I can't afford that so I have been getting copay assistance from several funding groups. They are not getting funding currently so that means I have will have to stop taking Xolair. THE REASON I JOINED THIS GROUP IS TO FIND PEOPLE THAT ARE GETTING COVERED BY THEIR INSURANCE COMPANY. so i can possibly switch from my current company to one that covers Xolair. Please list your company and what state you are in so other people can use the information. This is a great drug with a lot of people that are benefiting from it but can't afford it. PEACE ------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 17, 2010 Report Share Posted February 17, 2010 My BC/BS (we're with Empire but live in MD) and Medco work the same way. On Feb 17, 2010, at 12:40 PM, Gwendolyn Rafter wrote: > Blue Cross Blue Shield covers my Xolair. I am with the Alabama group but I live in Georgia. I pay $100 for a three month supply. Medco is the medical company and they get it from another company. All meds that we take on a long term basis has to be obtained from Medco. I had to pay $100 for the first three months but after that I went to every three months. I think you should talk with the specialist at the drug company first. They can help you. Janet Boss Best Friends Dog Obedience Baltimore/Ellicott City/Frederick MD Trainer/Instructor/Consultant Member; IACP #2574 Visit our website! www.bestfriendsdogobedience.com Contact me: janet@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 18, 2010 Report Share Posted February 18, 2010 I had a reaction to it a year ago and have been off of it since then, but when I was taking it; BCBS IL, through my employer. Medco provides prescription coverage for them, $72 for a three month supply, long term maintenance medicine. Hope you find a reasonable coverage. Debbie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 19, 2010 Report Share Posted February 19, 2010 > > How is it decided what insurance will pay? I used to have BCBS but Caremark > covered the medication. At first I paid $30 every 3 months, then they upped > it to $200 every 3 months. Now my insurance switched to United, but Caremark > still covers prescriptions and I pay $200 every 3 months. I guess it's part > of the benefit package my husband gets at work, so we would have no choice > on who provides the medication. I can't get any assistance because I make > too much money, but I am definitely not well off. > Also, I'm worried about what will happen when my husband decides to retire. > There is that nasty donut hole to consider. I'll probably have to stop the > medication, although I hope not. It's really helped. > Carol > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 19, 2010 Report Share Posted February 19, 2010 Try what Doug suggested or you can try Genentech Access Solutions. They provide the medication free of charge where insurance refuses to pay or pays very little for the medication. I use BCBS of Illinois and I get it through Caremark for $40 per month. Good luck, I hope it all works out. http://www.genentechaccesssolutions.com/xolair/patient/index.jsp From: Ol Wheezy <uca79iii@...> Subject: [ ] Re: Insurance Coverage Date: Wednesday, February 17, 2010, 11:32 AM  Teri, Welcome to the group Genetech has a Xolair debit card to help us with our deductibles. Call 1-877-411-8641. This helped me a LOT! Doug Group founder on Xolair for 6+ years Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 19, 2010 Report Share Posted February 19, 2010 Carol, Give Genentech a call. I thought I made too much as well, but they still found me some support. I had to take the attitude that if I don't ask, I wont get.....what did I have to loose but a few minutes of my time. Good luck with this. Mike ________________________________ From: Carol Corley <floridabouvs@...> Sent: Thu, February 18, 2010 3:43:16 PM Subject: [ ] Re: Insurance coverage  How is it decided what insurance will pay? I used to have BCBS but Caremark covered the medication. At first I paid $30 every 3 months, then they upped it to $200 every 3 months. Now my insurance switched to United, but Caremark still covers prescriptions and I pay $200 every 3 months. I guess it's part of the benefit package my husband gets at work, so we would have no choice on who provides the medication. I can't get any assistance because I make too much money, but I am definitely not well off. Also, I'm worried about what will happen when my husband decides to retire. There is that nasty donut hole to consider. I'll probably have to stop the medication, although I hope not. It's really helped. Carol Quote Link to comment Share on other sites More sharing options...
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