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Vest coverage denied
- Thread starter TB
- Start date
We have BCBS of ND. We were warned by the vest company that initially coverage would be denied; however, we'd probably get a request for more information regarding DS' health -- hospitalizations, culture results, was he on inhaled antibiotics... So we answered their questions. We were sent the vest, but still didn't know how much would be covered. The vest company explained the whole appeal process to us, indicated they did have financing available.
For the first several months we'd get calls from the vest company asking for the hours on the machine (checking that we were using it). Eventually we got a letter indicating how much we owed -- much less than the 20% I thought we'd have to pay and that the vest was now ours.
For the first several months we'd get calls from the vest company asking for the hours on the machine (checking that we were using it). Eventually we got a letter indicating how much we owed -- much less than the 20% I thought we'd have to pay and that the vest was now ours.
We have BCBS of ND. We were warned by the vest company that initially coverage would be denied; however, we'd probably get a request for more information regarding DS' health -- hospitalizations, culture results, was he on inhaled antibiotics... So we answered their questions. We were sent the vest, but still didn't know how much would be covered. The vest company explained the whole appeal process to us, indicated they did have financing available.
For the first several months we'd get calls from the vest company asking for the hours on the machine (checking that we were using it). Eventually we got a letter indicating how much we owed -- much less than the 20% I thought we'd have to pay and that the vest was now ours.
For the first several months we'd get calls from the vest company asking for the hours on the machine (checking that we were using it). Eventually we got a letter indicating how much we owed -- much less than the 20% I thought we'd have to pay and that the vest was now ours.
We have BCBS of ND. We were warned by the vest company that initially coverage would be denied; however, we'd probably get a request for more information regarding DS' health -- hospitalizations, culture results, was he on inhaled antibiotics... So we answered their questions. We were sent the vest, but still didn't know how much would be covered. The vest company explained the whole appeal process to us, indicated they did have financing available.
<br />
<br />For the first several months we'd get calls from the vest company asking for the hours on the machine (checking that we were using it). Eventually we got a letter indicating how much we owed -- much less than the 20% I thought we'd have to pay and that the vest was now ours.
<br />
<br />
<br />
<br />For the first several months we'd get calls from the vest company asking for the hours on the machine (checking that we were using it). Eventually we got a letter indicating how much we owed -- much less than the 20% I thought we'd have to pay and that the vest was now ours.
<br />
<br />
E
edan
Guest
We were denied with Blue Cross as well. My clinic's social worker recommended I ask for a case manager. It worked! My case manager knew about CF well (ex nurse who already dealt with CF patients). She coordinated for me what I needed (I.E. more info from the clinic, etc). What happened was the local managed care branch at Blue Cross denied the vest in writing to me due to "no other forms of airway clearance demonstrated as not working". But when I got the case manager involved she contacted them and they said they just needed more documentation from the clinic. It is their job just to deny, deny, deny.
We had NEVER had a hospitalization or cultured anything more than HIB at the time. After 6-8 weeks of fighting, the vest was finally delivered on a saturday. We were hospitalized the following monday due to an exacerbation.
The vest company also said they would call, but haven't. The insurance company said it was "on loan" for 3 months to make sure it was working. Not sure yet how we will get through that one in a month or so.
Ask for a case manager at Blue Cross. It really helped us so far.
We had NEVER had a hospitalization or cultured anything more than HIB at the time. After 6-8 weeks of fighting, the vest was finally delivered on a saturday. We were hospitalized the following monday due to an exacerbation.
The vest company also said they would call, but haven't. The insurance company said it was "on loan" for 3 months to make sure it was working. Not sure yet how we will get through that one in a month or so.
Ask for a case manager at Blue Cross. It really helped us so far.
E
edan
Guest
We were denied with Blue Cross as well. My clinic's social worker recommended I ask for a case manager. It worked! My case manager knew about CF well (ex nurse who already dealt with CF patients). She coordinated for me what I needed (I.E. more info from the clinic, etc). What happened was the local managed care branch at Blue Cross denied the vest in writing to me due to "no other forms of airway clearance demonstrated as not working". But when I got the case manager involved she contacted them and they said they just needed more documentation from the clinic. It is their job just to deny, deny, deny.
We had NEVER had a hospitalization or cultured anything more than HIB at the time. After 6-8 weeks of fighting, the vest was finally delivered on a saturday. We were hospitalized the following monday due to an exacerbation.
The vest company also said they would call, but haven't. The insurance company said it was "on loan" for 3 months to make sure it was working. Not sure yet how we will get through that one in a month or so.
Ask for a case manager at Blue Cross. It really helped us so far.
We had NEVER had a hospitalization or cultured anything more than HIB at the time. After 6-8 weeks of fighting, the vest was finally delivered on a saturday. We were hospitalized the following monday due to an exacerbation.
The vest company also said they would call, but haven't. The insurance company said it was "on loan" for 3 months to make sure it was working. Not sure yet how we will get through that one in a month or so.
Ask for a case manager at Blue Cross. It really helped us so far.
E
edan
Guest
We were denied with Blue Cross as well. My clinic's social worker recommended I ask for a case manager. It worked! My case manager knew about CF well (ex nurse who already dealt with CF patients). She coordinated for me what I needed (I.E. more info from the clinic, etc). What happened was the local managed care branch at Blue Cross denied the vest in writing to me due to "no other forms of airway clearance demonstrated as not working". But when I got the case manager involved she contacted them and they said they just needed more documentation from the clinic. It is their job just to deny, deny, deny.
<br />
<br />We had NEVER had a hospitalization or cultured anything more than HIB at the time. After 6-8 weeks of fighting, the vest was finally delivered on a saturday. We were hospitalized the following monday due to an exacerbation.
<br />
<br />The vest company also said they would call, but haven't. The insurance company said it was "on loan" for 3 months to make sure it was working. Not sure yet how we will get through that one in a month or so.
<br />
<br />Ask for a case manager at Blue Cross. It really helped us so far.
<br />
<br />We had NEVER had a hospitalization or cultured anything more than HIB at the time. After 6-8 weeks of fighting, the vest was finally delivered on a saturday. We were hospitalized the following monday due to an exacerbation.
<br />
<br />The vest company also said they would call, but haven't. The insurance company said it was "on loan" for 3 months to make sure it was working. Not sure yet how we will get through that one in a month or so.
<br />
<br />Ask for a case manager at Blue Cross. It really helped us so far.
I work with insurance companies everyday. They routinely deny or pend ALL CLAIMS OVER A CERTAIN DOLLAR AMOUNT. Don't be discouraged, that's what they are betting on! Use the resources at the Vest company. They probably have to appeal every vest they sell at least once.
Every insurance company has a set appeals process which involves many levels and appeals. You should request a hardcopy of this process from your insurance for reference. Pay special attention to the time limits they place on filing appeals. They WILL NOT cut you a break if you miss one.
I rarely work with Case Managers but use them as well. If you don't have one, ask if your insurance company uses a case manager service and request to be assigned one (usually an outside company contracted by the insurance company). They should (in theory) know the ins and outs to get you what you need.
Good luck! Be persistent!
Alanna
Every insurance company has a set appeals process which involves many levels and appeals. You should request a hardcopy of this process from your insurance for reference. Pay special attention to the time limits they place on filing appeals. They WILL NOT cut you a break if you miss one.
I rarely work with Case Managers but use them as well. If you don't have one, ask if your insurance company uses a case manager service and request to be assigned one (usually an outside company contracted by the insurance company). They should (in theory) know the ins and outs to get you what you need.
Good luck! Be persistent!
Alanna
I work with insurance companies everyday. They routinely deny or pend ALL CLAIMS OVER A CERTAIN DOLLAR AMOUNT. Don't be discouraged, that's what they are betting on! Use the resources at the Vest company. They probably have to appeal every vest they sell at least once.
Every insurance company has a set appeals process which involves many levels and appeals. You should request a hardcopy of this process from your insurance for reference. Pay special attention to the time limits they place on filing appeals. They WILL NOT cut you a break if you miss one.
I rarely work with Case Managers but use them as well. If you don't have one, ask if your insurance company uses a case manager service and request to be assigned one (usually an outside company contracted by the insurance company). They should (in theory) know the ins and outs to get you what you need.
Good luck! Be persistent!
Alanna
Every insurance company has a set appeals process which involves many levels and appeals. You should request a hardcopy of this process from your insurance for reference. Pay special attention to the time limits they place on filing appeals. They WILL NOT cut you a break if you miss one.
I rarely work with Case Managers but use them as well. If you don't have one, ask if your insurance company uses a case manager service and request to be assigned one (usually an outside company contracted by the insurance company). They should (in theory) know the ins and outs to get you what you need.
Good luck! Be persistent!
Alanna
I work with insurance companies everyday. They routinely deny or pend ALL CLAIMS OVER A CERTAIN DOLLAR AMOUNT. Don't be discouraged, that's what they are betting on! Use the resources at the Vest company. They probably have to appeal every vest they sell at least once.
<br />
<br />Every insurance company has a set appeals process which involves many levels and appeals. You should request a hardcopy of this process from your insurance for reference. Pay special attention to the time limits they place on filing appeals. They WILL NOT cut you a break if you miss one.
<br />
<br />I rarely work with Case Managers but use them as well. If you don't have one, ask if your insurance company uses a case manager service and request to be assigned one (usually an outside company contracted by the insurance company). They should (in theory) know the ins and outs to get you what you need.
<br />
<br />Good luck! Be persistent!
<br />
<br />Alanna
<br />
<br />Every insurance company has a set appeals process which involves many levels and appeals. You should request a hardcopy of this process from your insurance for reference. Pay special attention to the time limits they place on filing appeals. They WILL NOT cut you a break if you miss one.
<br />
<br />I rarely work with Case Managers but use them as well. If you don't have one, ask if your insurance company uses a case manager service and request to be assigned one (usually an outside company contracted by the insurance company). They should (in theory) know the ins and outs to get you what you need.
<br />
<br />Good luck! Be persistent!
<br />
<br />Alanna
crickit715
New member
our vest coverage was denied at first, then a month later my daughter cultured pa for the first time and they approved then they approved the vest. i dont know if the culturing of pa had anything to do with the approval or not.
crickit715
New member
our vest coverage was denied at first, then a month later my daughter cultured pa for the first time and they approved then they approved the vest. i dont know if the culturing of pa had anything to do with the approval or not.
crickit715
New member
our vest coverage was denied at first, then a month later my daughter cultured pa for the first time and they approved then they approved the vest. i dont know if the culturing of pa had anything to do with the approval or not.