Health Insurance

[Ivy]

I live in Chicago and have Blue Cross Blue Shield health insurance PPO and in 02/01/07 and 09/11/07 my daugther Josi had surgery done with Dr. Nath., 1st the mod-quad and then after the triangle tilt. My question is there anyone who had any problem getting their health insurance to pay for the surgery perform by Dr. Nath? if so any advice how to get these medical bills paid for!

[Mare]

Contact Dr Naths office they will either tell you how to handle it or will contact the insurance co for you. Thats what I did. Mare

[georgia's mom]

I have the same insurance and I have just been denied for the Triangle Tilt Surgery. What did you have to do to get the surgery approved or did you out of pocket for both?
Any information would be helpful. My email is ktj01@doc.state.nc.us.

[aidansmom311]

I was brought to tears when first denied by Blue Shield! We have since changed companies due to where my husband works. Their excuses were many! My mom in law works for an insurance company and she told us at the time to just keep calling and fighting and getting letters, etc. She reminded us that with insurance companies "The squeaky wheel" is definately the one who is heard. Never give up! Kep fighting for what you know is right!

[melnruss]

GAMOM,
I have the same insurance and they gave me huge problems paying for my son's therapy after his 1st birthday due to diagnosis issues. Anyway, we went round and round and round. Finally, I told them that I was getting the insurance commissioner's office involved. Two hours later, I received a call from a supervisor stating that his claims were all being paid. Don't be afraid to get nasty. Threaten to come up to the BCBS office in Atlanta in person. They really don't want you to do that:) Don't get discouraged and just be patient and persistant. The squeaky wheel is the one that gets heard.

[Carolyn J]

It IS very helpful to make a call to your State's
Insurance Commissioner's Office.
Carolyn J


Message was edited by: Carolyn J

[Mica]

Melinda,

Thank you so much for that tip! Aetna has cut Aria off from PT, stating she's "maxed her PT benefits" because they are refusing to recognize her bilateral injury as one injury to her left arm, and one injury to her right.

The severity of the injury is different (one arm needed primary, one did not), they did not happen simultaneously, and even Dr. Kozin considers them individual injuries.

We've appealed Aetna's decision, and right now it's before a panel of "board certified nurses." I think we'll call them on Monday and let them know we'll be speaking with the Maryland Insurance Administration regarding their creative ways to deny a baby medical services.

Again, thanks for the tip. It really is "us" against "them" sometimes, isn't it???

*sigh*

[Mare]

ATENA denied us saying our employers contract State of NJ only covered 60 visits per condition and they could not change the contract I got the same answer after 2 appeals both done with the doctor and surgeon's letters explaining how the surgery that was done required further therapy in order to work. I don't get it they covered the surgery with no problem why waste the money and put the child through he-- if your not going to follow through with therapy. Mare

[mlynn]

I would apply for medciad for what ur insurance will not cover, there are special needs programs meven if u make to much money. you might need to ask for a hearing from the people in charge.

[Mare]

In NJ it all comes down to your income thanks anyway
mare