Aetna has authorized DOC band... yay! (m)

[Guest guest]

Judy and Marci,

Let me in on this! Annie was diagnosed with positional plagiocephaly on 03-14-01. Aetna is our insurance provider and said they'd pay for a STAR band but not a DOC band. Our Dr. said he would NOT let her be put in a STAR band. What's your story? Our Dr. is really fighting on our behalf to get Annie into a DOC band.

Could you please give me NAMES of the people you're working with at Aetna?

Thanks a lot!

Benita

[Guest guest]

Benita,

What was the rationale your insurance gave for paying for the STAR and not

the DOC? Why is your dr so opposed to the STAR? Sorry, I don't have Aetna so

I can't help with that. Sorry!!

Marci (Mom to )

Oklahoma

[Guest guest]

Marci,

I'm not 100% sure, but it was less expensive. My doctor is handling the fight for us to get the DOC band. But I can't help but get into the game myself.

Annie's screaming. Gotta go...More later...

Benita

[Guest guest]

They even authorized it at the in-network rate (90%).

I am relieved!

Judy and Genna (banded 3-13-01)

[Guest guest]

Benita,

I emailed you. I don't have any helpful names at Aetna; CT handled

most of it and I just called the number on the insurance card to

check status.

The link to Aetna's guidelines on treatment of plagio is:

http://www.aetnaushc.com/cpb/data/CPBA0379.html. They mention DOC on

this webpage.

Hope this helps.

Judy

[Guest guest]

Judy,

I also have Aetna and they authorized us to have the DOC Band made at

an out-of-network cost. There is a letter from both our PCP and our

out-of-network specialist. I would think that they cover it at 100%

but still waiting. How do you mean that they only covered it at

90%? Why didn't they pay for the entire thing?

My only concern is they will only cover at out-of-network cost

because the script came from the specialist (sent to have it

authorized) before our PCP.

Selena and Ian

banded 3/6/01

[Guest guest]

That's great Judy!!

--- mom2genna2000@... wrote:

> They even authorized it at the in-network rate

> (90%).

>

> I am relieved!

>

> Judy and Genna (banded 3-13-01)

>

>

__________________________________________________

[Guest guest]

We also have Aetna :-( and they are paying for the whole thing minus

any copays 15.00 :-). They covered it under the DME. So the whole

thing is paid for. Not knowing what your plan is with them I can't

say for sure how they would handle it but if you are on the HMO it

should be covered. Also they are covering a helmet for us not a Band

did they ever speak of that? I wonder why the different methods of

treatment. Got to go get formula. Bye for now.

April (mommy to Bri and Mandy)

> They even authorized it at the in-network rate (90%).

>

> I am relieved!

>

> Judy and Genna (banded 3-13-01)

[Guest guest]

Great news! Well done on a hurdle cleared!

It's reassuring to me too - we have Aetna USaccess and are just

embarking on getting authorisation. So far, on the phone, they have

said that, as long as the referral comes from our PCP, it will be

fine. I assume the only bill we will get is our co-pay. However, it

is still early days with us, so Ill let you all know if they get

awkward further down the line! Cant help but be pessimistic with

these people!

Kimberley (Mummy to Evan and Hope)

> They even authorized it at the in-network rate (90%).

>

> I am relieved!

>

> Judy and Genna (banded 3-13-01)

[Guest guest]

Ours was preauthorized, we are still waiting for payment however.

We have Aetna PPO.

Kathy

mom to

l lamdoid CVR 1/18/01

DOC Band 2/25/01

[Guest guest]

Hey Selena,

Our plan's benefit is 90% for in-network providers. CT is actually

not in their network, but since they are the only provider of the DOC

band, they are covering it at in-network rates. Our Rx came from the

specialist too (pediatric neurosurgeon).

I suppose different plans might have different % benefits; our in-

network benefit is 90%. It is considerably lower for out of network

providers. If I were you, I would at least make the argument that

since there is no other provider, they should cover it at the in-

network rate. CT should be able to help you with this; they know the

ins and outs of dealing with the various insurance companies.

Judy