...from Kerre as I was pulling into the apartment parking lot. She was telling me that the helmet place just called and they said that the insurance said they would not cover Jacks helmet. I was hacked off.
I have talked to our insurance on average of every other day it seems and had heard a number of times that they would cover the helmet. Plus, one of Dr. Genecov's stipulations on doing a limited cranial vault is that insurance pay for the helmet.
So, when I walked in the door and got the rest of the story from K, I quickly dialed the helmet place. She told me exactly what K had told me; that the helmet was "cosmetic" and therefore would not be covered by insurance.
So, in my "nice voice", which was not very nice I proceeded to tell her that it was ridiculous that we were getting this call at 5:30pm the day before his helmet appointment. We have known about this for a month and a half and I am sure they have know about it longer than a week and this should have been taken care of. After she listened to me rant, she preceded to tell me that the total cost was $2100 and that we could just pay out of pocket and then get reimbursed by insurance and all that we had to have tomorrow at the time of appointment was $600. (How nice of them I am thinking to myself. They will just let me pay for this. Yeah!)
Ok, so now it is 6pm and I still have no answers. A desperation call to Aetna. Maybe some one is there; and low and behold, Donna answers the phone. I give her all of the details and the procedure code the helmet place gave me and I waited wh on hold while jack cooed at his baby einstein. She informed me that the procedure code was no longer valid and that the helmet was covered, becuase of the surgury and he was between 4 and 12 months. Whew!
My question now is, would the person from the helmet place not have told them the exact same thing I did? This have been a very information situation with going through insurance and I. I guess you can't call too many times.
I have talked to our insurance on average of every other day it seems and had heard a number of times that they would cover the helmet. Plus, one of Dr. Genecov's stipulations on doing a limited cranial vault is that insurance pay for the helmet.So, when I walked in the door and got the rest of the story from K, I quickly dialed the helmet place. She told me exactly what K had told me; that the helmet was "cosmetic" and therefore would not be covered by insurance.
So, in my "nice voice", which was not very nice I proceeded to tell her that it was ridiculous that we were getting this call at 5:30pm the day before his helmet appointment. We have known about this for a month and a half and I am sure they have know about it longer than a week and this should have been taken care of. After she listened to me rant, she preceded to tell me that the total cost was $2100 and that we could just pay out of pocket and then get reimbursed by insurance and all that we had to have tomorrow at the time of appointment was $600. (How nice of them I am thinking to myself. They will just let me pay for this. Yeah!)
Ok, so now it is 6pm and I still have no answers. A desperation call to Aetna. Maybe some one is there; and low and behold, Donna answers the phone. I give her all of the details and the procedure code the helmet place gave me and I waited wh on hold while jack cooed at his baby einstein. She informed me that the procedure code was no longer valid and that the helmet was covered, becuase of the surgury and he was between 4 and 12 months. Whew!
My question now is, would the person from the helmet place not have told them the exact same thing I did? This have been a very information situation with going through insurance and I. I guess you can't call too many times.
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