preauthorization?

[*Alicia*]

Has anyone else had to wait to get their child's helmet because it had to be preauthorized by insurance? Also, if so, what's the average wait time and will calling the insurance daily help at all?!?

THX! :-)

[Mena]

Hi Alicia -
My daughter Audrey wore a helmet after her surgery for sagittal. We did not need be pre-authorized and she was fitted and in her helmet three weeks after her surgery. I will tell you though that I am currently fighting insurance for the helmet - it's $1800 and they are telling me that it's cosmetic and they won't cover it. I'm currently working with my surgeon and orthotist to get this handled. They are just as furious as I am. I don't mind fighting now....my concern was getting her in the helmet as soon as possible after her surgery.
Thanks!
Mena

[Avery's Mom]

The Orthotics people told us they would go to the insurance for authorization as they had the helmet made. We had to sign a form saying we agreed to make arrangements to pay if the insurance did not. It took three weeks for the insurance to respond...by then Avery was wearing it. lol

[Sophia's_mom]

We've had to fight to get both helmet's covered but the orthotics place always gives up the helmet with or without authorization from the insurance. So far, they have paid for both of them. I hoping there won't be a third one.

[CalinaLily]

If any of you are having issues with appealing denials for insurance to cover this, let me know. I had a successful appeal (and have a pretty darn good letter I'd be willing to share). The biller at Star Cranial (our orthotist) was actually quite surprised we were able to get our helmets covered by insurance because they are so frequently denied and people don't fight very hard to get them covered. We're a bit more stubborn than that and know injustice when we see it. :)

We weren't able to get "preauthorization" for our helmet because United are dumb-bunnies and told us they can't authorize something they haven't been billed for, and they can't be billed until the helmet is "delivered". So, pretty much in all cases, you have to either pay out of pocket up front (and hope you can win the battle that's forthcoming) or get lucky with an orthotics company willing to take a risk on you while they wait and see (and let them hope they can win the battle). We had to deal with the first: Star wouldn't "front" us our helmet. We had to pay 50% when it was ordered and 50% when it was delivered -- so $1100 on a Tuesday and $1100 the following Friday. Nice, huh?

Anyway, please let me know if you (or anybody else here) needs help with insurance crap. We fought the good fight and won the day. Hoorah!

[Leighasmom]

We went ahead with the helmet after the 2nd insurance denial. (the first denial came the day after her surgery while we were coping with PICU). We had a wonderful surgeon and ortho fighting for our coverage and after the 4th denial we finally got coverage after I yet again fought it. I think I wore them down with all the appeals and all the information I kept slamming them with. It sucked but I just hit them with more rebutals....okay say its cosmetic...lets talk about children's looks and how that can effect their psychological well being...say its not medically necessary wel then I'm slapping you with all the plagiocephaly info and how head shape can affect eye sight, hearing, ear infections, jaw alignment. Keep you're chin up insurance is a pain in the ass sometimes their game is to save their client(not you but the actual insurance company) $$$

[Leighasmom]

Hi Alicia -
. I'm currently working with my surgeon and orthotist to get this handled. They are just as furious as I am. I don't mind fighting now....my concern was getting her in the helmet as soon as possible after her surgery.
Thanks!
Mena

Ha ha ha Mena I love it when the ortho and Dr gets involved. I heard our Dr tell the insurance guy he was a real prick for denying coverage the day after surgery. lol I guess according to our Ortho the guy we had reviewing the coverage never paid out on the bands and they were all pretty tiered of dealing with him. Glad we beat the jerk down :snap
We didn't have to pay and then wait for insurance to pay thank God because we didn't have the money to do that(almost $5000 total). Leigha would have went unhelmeted. By the time we got the approval Leigha was almost ready to graduate from the band.