Insurance denied our claim for the helmet! :(
auburnbride2be
member
I'm on hold with the Dr. office to find out what to do now, but the letter states two reasons for denial:
No diagnosis of plagiocephaly and they require 2 months of physical therapy before covering it.
I feel like there is nothing we can do now. I'm going to try though. The Nuerosurgeon said they always say it is medically necessary. I have seen improvement, but her head is still lopsided. I just don't want to risk it being obvious later. She doesn't have much hair now, so it is hard to gauge how much that will help. She is only on her back or putting pressure on her head when she sleeps (usually on tummy though), in her carseat in the car or when I change her or feed her.
If money wasn't an issue at all, I would totally just pay for it and do it, but my job is unstable and we don't have much extra money anyway.
Re: Insurance denied our claim for the helmet! :(
How much is the helmet?
Can you play their game and wait the 2 mos physical therapy?
Ugh! Insurance companies really suck. I hope your doctor is able to make the insurance company understand why the helmet is necessary now and cover the charges.
My insurance company tried to deny the claim for my CT scan last week, saying it was uncessary. Hello? I need surgery and the CT scan reveals where the issue is. So stupid!
That is a lot of money. Try to go the phys therapy route if you can. Demand a diagnosis, too, while you are at it.
I would definitely try to get the diagnosis from the dr as well as try to get physical therapy going. Seriously, insurance companies are so incompassionate and just money hungry! I've been arguing with them all week long regarding my short term kicking in and they're just ridiculous.
I'll keep you guys in my thoughts and prayers. (hugs)
Appeal it. Start playing their game. Many times insurance companies will deny pricey claims. Keep at them. Demand help from the doctors, since they were the ones that prescribed one for her. In the end, I think you'll see that the squeaky wheel gets the oil.
There's a reason why insurance companies make a ton of money. They are stingy and will try to deny anything they deem "optional".
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Please don't give up! Please keep on them. I fought for Nkosi asthma treatments to be insured as they kept dening him saying it is a pre-exsisting condition. Hell ya he was born with it mutha...anyway. I am, getting angry. Insurance companies in the US suck. I never had to pay for anything in Bermuda under my insurance. Nothing! Eyecare covered, baby delivery covered, everything COVERED!
After a year they insured Nkosi but only after I had forked out over 1000 bucks to get him allergy tested. Please appeal and see what other options you can do. Don't let them dictate your babies future.
Keep us posted and Good Luck.
I'm a lurker but saw your post and was pretty upset about it so I asked my husband if he would help you out as a a favor to a fellow nestie and he said no problem-he's a private practice attorney and deals with insurance companies all the time. I'm sure he could make some phone calls and send a letter on your behalf to get them to approve it.
Email me at slandsl2007@yahoo.com and I will put you in contact with him.
Sonia