Surprise bill for the helmet

[Jen]

So all along everyone told us including our consultant for plastic surgery and even the secretarys at the prostetic office that our helmet was covered by insurance. Today we got a bill in the mail for half of the helmet which is a little over 1500 dollars. That is just for the first helmet. We just got his second helmet so that will be another 1500. We had no idea we were going to have to pay anything at all, and this is a lot of money that we dont have! Did anyone else have this problem? Did anyone actually pay these large amounts of money for their helmets? Any advice would be great, this is really stressing us out!
Thanks,
Jen

[jjmc123]

I hate when insurance misleads you! My son didn't have a helmet so I can't give advice, just sorry you have to deal with this.

[Sophia's_mom]

No, don't pay it right away. Call your insurance company today and see why the claim was denied and then ask them what they need from the doctor or the Ortho to approve the claim. Once you have that info you should be able to have the bill resubmitted with the correct code or more info and they should pay. this surgery requires helmet therapy and it should be covered. We never had to pay out of pocket at all for the helmets.

[G2sMama]

Have you tried calling the insurance company? If not, please do. If you have, call them again & ask what they need from you (or the surgeon) to get it covered. We were told ours were covered, but when the orthotist called for approval, we were told it wouldn't be. So we called insurance and they agreed to pay 80%. It is a necessary product and should be covered. Some won't cover for plagio helmets, but for surgery, it's ridiculous not to. You may have to get the surgeon's office to help you.

I'm sorry you are dealing with this. :hugg

[G2sMama]

Haha. Looks like Tessa & I are on the same page.

[Sophia's_mom]

Almost word for word.

[JillysMama]

I second and third everything the other Moms said. Whenever I get bills unexpectedly regarding medical costs I always call the insurance company. 99% of the time they take care of the cost and all ends well. Good luck!

[Jen]

Thanks everyone! That is reassuring to hear. We are going to call the insurance company tomorrow and are going to go through the appeal process. I just hope they wont put up too big of a fight!

[G2sMama]

Please let us know how it goes!