preauthorization?

*Alicia* · 10-04-2009, 08:57 PM

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 · 10-04-2009, 09:17 PM

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 · 10-05-2009, 07:30 AM

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 · 10-06-2009, 10:38 AM

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 · 10-10-2009, 09:57 PM

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 · 11-20-2009, 12:38 AM

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 · 11-20-2009, 12:45 AM

Quote:

Originally Posted by Mena

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

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.

10-04-2009, 08:57 PM	#1
Alicia Mom to Anessa and Abram Join Date: Jun 2009 Location: WV Age: 29 Posts: 54	preauthorization? 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! :-) __________________ Alicia Anessa Corinne - 1-11-08 (no cranio) Abram Alexander 6-20-09-fused sagittal suture - CVR 9/21/09 with Drs. Horswell and Mazagri We're on the other side!!!!! "How much of human life is lost in waiting"~Emerson

10-04-2009, 09:17 PM	#2
Mena Join Date: Mar 2009 Location: Grosse Pointe Park, MI Age: 36 Posts: 24	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 __________________ Mena Mommy to Audrey (10-06-08) sagittal synostosis (surgery 01-08-09) "on the other side"

10-05-2009, 07:30 AM	#3
Avery's Mom Join Date: Feb 2009 Location: Atlanta GA Posts: 2,812	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 __________________ Kelle Mom to Samuel Avery Born August 10, 2007 Right Lambdoid Cranio Complete bilateral cleft lip and palate Surgery at CHOA April 14, 2009

10-06-2009, 10:38 AM	#4
Sophia's_mom Join Date: Mar 2009 Location: Columbia, Missouri Age: 28 Posts: 2,581	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. __________________ Tessa mom to Sophie - Endo surgery 4/16/09 and Helmet Grad 12/21/09 - St. Louis Children's

10-10-2009, 09:57 PM	#5
CalinaLily Join Date: May 2009 Location: Orlando, FL Posts: 132	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! __________________ Melanie Calina Lily born 3/19/09 Sagittal Synostosis - diagnosed at birth Endoscopic surgery with Dr. Johnson & Dr. Ruiz 6/17/09 StarLight helmet therapy with Star Cranial started 7/13/09 & graduated 4/5/10 My Mommy Blog - including our cranio journey Before and After surgery photos

11-20-2009, 12:38 AM	#6
Leighasmom Join Date: Nov 2009 Location: Omaha, NE Age: 33 Posts: 1,106	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) $$$ __________________ Mel ~ Beyond A Glimpse Mommy of Austen 12/21/96: ADHD~normocephaly Leigha 7/22/00: Bicoronal Cranio~CVR with FOA May 2001~DOC band graduate Sept. 2001 Fought insurance & won on 4th appeal~2nd reconstruction summer 2011 w/Dr. Fearon Colton 3/24/09 normocephaly OUR Story

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