So as most of you already know, we were advised to put Anaïs in one of those temporary helmets to correct her head flattening. The cost of this is pretty high. Well, I just got off the phone with their insurance coordinator and our insurance is refusing to cover it! They say that it's cosmetic so they won't cover a penny! COSMETIC??????? Ok, it's not like Anaïs is getting a boob job!!! This is ridiculous and I am furious!
I feel so cheated by the system, I seriously feel like they don't care about her well being. I feel that she deserves to get the best care out there and that she will have to face enough challenges in life. I really hope the health care system will change one day, we can't keep on doing this to people. We have the best healthcare available but it's so expensive that people who do get sick and need it can't even affort it...RIDICULOUS!
I am too mad to even write anything else.
My Longtime Goal Has Come True
4 weeks ago
11 comments:
I don't blame you! It's amazing the number of things that insurance companies will try to avoid paying for despite the advice of doctors. We think that has a lot to do with why our geneticist is fighting us on the tests as much as he is, because Kaiser doesn't want to pay for them... Let us know how it goes - and meanwhile, we'll pray/spin a wheel/cross our fingers or whatever we can do for you!
The insurance companies are RIDICULOUS! I have spent the last 14 months fighting with them over every single penny. We have been screwed over by them on numerous occasions as I watch our savings account dwindle down. I'm sorry you are having to deal with this. Just remember to keep fighting!
Oh, Alex, I'm so sorry. How frustrating for you. I am in complete agreement...our health care system is absolutely, utterly ridiculous. I recently watched a documentary about it, so I am particularly fired up! Don't give up. Keep on fighting, and there will be a way.
I know this frustrating, Alex...have you tried to work the system? What I mean by that is that sometimes insurance companies escalate or appeal a claim. It's extremely beaureacratic and time-consuming but if you keep appealing, someone might eventually agree to covering a portion of it, if not all of it. I would also double check with her neurosurgeon, maybe he can help you guys out? The other thing you can do is find out if another mom in our group had a baby with head flattening and has one of these helmets lying around (they don't have to be custom-fit do they?) That sucks, regardless!!!!
Liz, they DO have to be custom fit. :(
My girlfriend's daughter was in a helmet and there is a woman on my blog list whose son was in a helmet. (Check out the blog Valiant Family Updates) He was in the helmet a while back but I know she blogged about it and has her e-mail address on the blog too. Her name is Renay.
Can't the doctor state that she has plagiocephaly (sp?)? I would think a doctor's diagnosis would help a bit.
Is Anais ready to roll? Preston's head was flat, but his eye sockets or ears were not affected. As he learned to roll the flattening did even out a bit.
Please keep us posted!
My friend went through the same thing you are going through right now with insurance. She initially had to pay out of pocket for the helment, but continually called and wrote letters stating her case and why insurance should cover part of the helment cost. SHE WON HER CASE AND INSURANCE HELPED PAY FOR ABOUT 75% OF THE COST!!!!
If you would like me to email her and ask what she did or ask if she still has the drafts of the letters she sent, I would be happy to do so for you. Hope everything turns out well and don't give up, just keep fighting!!!!
Maybe insurance companies will see how non-cosmetic a helment really is and start to cover it on insurance policies!
Hang in there!!! Urr.. Insurance comapnies are SOOOO Frustrating. Keep us posted. Hopefully, you'll get some good news soon.
Lisa, Brian and Liz
Ugh...... That sucks. Insurance seems to do just the opposite of what they're supposed to. (Love the boob job comment though) ABout every three months, we have to get in a two-month long fight over all of my medications, because there are cheaper, generic versions avasilable that don't work! Anyway, hang in there and I hope things get betterr/
Liz is right...if you want to pursue it, you can appeal the denial. Also, if you haven't already, maybe you'll want to consider a 2nd opinion. Jake also (and still kind of does) had a flat head. Like Kim said, it gets better when they learn to roll. Sorry you have to go through this...
Hi,
I know that I am from another country (Canada) and what I was told from the OT's is that if you are making a conscious effort and have made the applicable appointments and have followed what you have been told by the professionals from the beginning ( who all have to write you and the insurance company letters stating that it is not cosmetic and that the parents have done everything in their power and have followed Dr's orders, and her condition - stressing her Achon, large head, unable to move neck, low muscle tone ect.....) that it should be covered. Making sure that the word COSMECIC is not used at all.
Get letters from the OT. Hope this helps
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