Star Cranial - INSURANCE!! Arrgh.....

[CalinaLily]

I totally got the run around from the secretary at our Star Cranial office today. She basically told me that, even though our insurance (United) said that our helmet will be covered by our policy, we will still have to come up with the money out of pocket in order to place the order for it and "receive" it. She says this is because it takes 30 days to process the payment request with United, but I'm realizing after the conversation that she gave me conflicting information:

-She said that they can't bill United until the helmet has been delivered. But the helmet must be paid for in full when we get it. So... I asked her if EVERY family has to come up with the cash out of pocket and hope the insurance comes through to reimburse? And she sort of said yes, in a round about way, but then...

-She tried to blame ME by saying that if she had known for sure that we would be getting a helmet, the paperwork could have already been underway. It was MY FAULT that the paperwork wasn't already done with because I hadn't returned her calls to make an appointment in the last week -- our surgeons wanted to check her incisions before we went in to get a helmet. EXCEPT that we went in for a preliminary scan 3 weeks ago, and said that we would for sure be needing a helmet post-surgery.

Then she tried to blame my surgeon, saying that she had spoken to their office several times, requesting a letter of medical necessity for her to submit to the insurance company. (I was just there today, and they said they had not heard a word from here in my regard.)

This kind of garbage REALLY burns me up. Is this a scam, or what?? :help

[KarenD]

How frustrating! We just got our STAR helmet last week and have had no contact with them directly. Our orthotics office is totally dealing with it and I'm positive they didn't get the approval before they ordered it. They said it takes too long so they send the insurance request and order the helmet at the same time then they fight with the insurance company as long as they need to. Can you talk to your Orthotist and ask them to help out? Best of luck.
karen

[dannlark]

Firstly, I must tell you WHAT A DIFFERENCE his surgery has made already to his head shape, WOW!!! You must be very pleased. As for United. We have them too and they have been VERY accomedating with everything. Do you have a case worker that you are in contact directly with in their offices? If so, try and speak with that person and explain how important it is that you get this helmet sooner than later. They have Dr.'s on staff to make those kinds of judgement calls, so see if he/she can get involved too. Make them realize that it is a WHOLE proceedure, the helmet is part of that, not a seperate identity. The endo, FOLLOWED by the helmet is the treatment for craniosynostosis when it is done at this early age. They save 50's of thousands of dollars by you guys choosing this option of treatment. You have to be a hound dog with them, don't let up until they understand it all and you get what you want and your beautiful baby needs.

[CalinaLily]

I just can't help but feel like I was a little bit hoodwinked at the outset. I really made it totally clear to a half a dozen different professionals, including Star Cranial, that we'd be doing the endo surgery followed up by helmet treatment, and not a single person - not a single one! - even mentioned to me that I might want to get in touch with the insurance company to get the ball rolling ahead of time. I ABSOLUTELY would have, if anyone had mentioned anything about this stuff before. How stupidly frustrating it is to just not be informed.

Thank GOODNESS that we have enough money on hand to get things rolling anyway. But I can so easily imagine plenty of families that would be stuck, absolutely stuck, in our situation... Having to come up with $2200 in 5 days with NO advance warning?? That is just EVIL.

I just found out about all of this at 5:30 today when everyone else I could talk to was already done for the day. We have an appointment to get our scan tomorrow morning at 9:30 am, when I'll be expected to fork over half of the money to order the helmet. I don't think it's likely I'll have a chance to get United to help me out before then. Sheesh.

[Zara's mum]

I too have to say wow, he is looking fab! You must be so pleased. i am so sorry about your frustration with the insurance for the helmet.... It's just ridiculous that they didn't mention to you from the start to begin paperwork.. I really hope something can be sorted, no one has that sort of money in their back pocket... :hugg

[heatherific]

i know this is an older post, and i hope by now you've gotten all this mess figured out. i was just dealing with billing yesterday (still, her surgery was 8 months ago!). i spent 2 hours dealing back & forth with insurance & medical billing. unbelievably, the insurance was VERY helpful & willing to pay, but the billing office was being a pain. apparently they just didn't feel like filing the paperwork, or were too lazy to figure out the problem. so anyway, the point is for anyone who's having trouble with billing & insurance, it might be good to call the insurance company directly. my insurance company told me the specifics of what the doc's billing office needed to do, then i was able to call them back & tell them exactly what to do. but even still, after the insurance companies said they'd pay it all the billing lady STILL wanted me to pay it in the mean time & they'd reimburse me when the insurance came through. i told her to take a hike. do these people work off commission or something???

btw, calina looks amazing!!! :)

[Avery's Mom]

We also have United and have had no issues with either of Avery's helmets but, like KarenD said, the Orthotics place handled it all directly. We did nothing except sign a piece of paper saying if they did not come through we'd arrange payments to cover it. What a CROCK.

[Sophia's_mom]

I'm so sorry Melanie! I didn't use Star and luckily we didn't have an issue with the Orthotic company wanting us to pay before they had submitted the claim to our insurance (we also have United). I'm sorry that you won't have the chance to fight them on it before you have to go today to get scanned. It sounds like someone in the billing office messed up and is just trying to pass the blame around. Good luck today, I hope it goes well.

[Josephsmommy]

Don't give up, call the insurance company yourself and ask them what's going on. I have Cigna HMO and our helmet was covered in 2 days. The helmet office at Miami Childrens hospital handled everyhting for us but I had told them to go ahead and order it and I would take care of talking to the insurance if need be. I advsied them that I would tell the insurance that it's either going to cost them $2,400 or a possibility of having another $50,000 surgery. What would they prefer? Thank Goodness I didn't needed to go that route but boy was I ready. Good Luck!

[CalinaLily]

Do any of you ladies who also have United have the EPO plan? We just received a letter today denying coverage for our helmet. Just checking.

[Avery's Mom]

I have the Premier PPO plan with United.

[CalinaLily]

:yipee Great news!! I got a call today from STAR letting us know that United paid them today, so we'll get reimbursed for our helmet!! If anybody happens to come across a similar issue, I'd be happy to share the letter of appeal we submitted after we were denied. The billing rep. at STAR said she thinks that our letter was what did it for us -- and that many other parents facing similar problems will get a lot of mileage out of our legwork. (We worked in tandem with a lawyer friend of ours.) What a darn relief!!

[*jules*]

great news Melanie. I'm so glad your ins pulled their head out of their butts and paid up! way to fight for your little girl :)

[Sophia's_mom]

Wonderful news Melanie! We had an insurance "fight" when we had to get the second helmet. They still haven't paid for it yet, but I think they are going to come thru. If not, I may be asking for a copy of your appeal letter.

[*Jessica*]

That is fantastic news!!! I am so glad that they finally forked over the cash!