Re: DENIED BAND-Trigon BCBS of VA

[Guest guest]

Monroe,

We are in the same shape and timing as you with Virginia. Our

pre-authorization was denied by Horizon BCBS-NJ. I have sent one appeal

through my company's corporate office. Hopefully you can do this as well in

your situation. Corporate benefit people will tend to work with their

Account Representive (i.e. sales rep) at BCBS. They should have already

established a good relationship with that person. At least it should be

better than calling a customer service rep on a 1-800 number.

Scan the recent postings for TEC in the subject. It refers to BCBS's

technical evaluation committee, and that's where the " investigational "

policy may stem. They reviewed the technology in 1999 and then decided

decided it was covered. Regrettably, this document isn't free to the

public. The BCBS-Massachusetts site has some insight into this TEC study.

(www.bcbsma.com/hresource/068.htm) This is their denial policy for DOC

banding. It's frustrating to read, but it helps one to know one's

adversary.

One angle I am trying is a policy statement from Aetna

(www.aetnaushc.com/cpb/data/cpba0379.html) You may have to play with the

URL to find the actual document. But, Aetna does cover orthotic banding

when clearly defined anthropometric data is met (asymmetries greater 6 mm or

cephalic indices greater or less than 2 standard deviation from the mean).

If BCBS and Aetna are options you had from your company and your child meets

the Aetna criteria, you should have some confidence in saber-rattling to get

your benefits office to act.

I've found alot of good tips for insurance by watching this group over the

past few weeks. I'll try to post our appeal letters soon, but first I have

to figure out what my logon name and password are.

Will

----Original Message Follows----

From: thekeenes@...

Reply-Plagiocephaly

Plagiocephaly

Subject: DENIED BAND-Trigon BCBS of VA

Date: Fri, 16 Mar 2001 16:51:48 -0000

We received a letter this week from Trigon BCBS of VA denying

authorization for a band for my 5 month old son who was diagnosed

with moderate plagiocephaly last month. The reason given

was " investigational/experimental " .

We are proceding with treatment as we have waited for over two weeks

for authorization. By the time he is casted and gets his band

another valuable month will have gone by.

We plan on appealing. Anyone with advice or insight would be greatly

appreciated.

Thanks,

Monroe Keene

Yorktown, VA

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[Guest guest]

Monroe,

What device are you using?

Marci (Mom to )

Oklahoma