Well i called BCMH this morning (Ohio's government plan for children with chronic medical conditions). Unfortunately while a lot of his pediatric orthopedic colleagues are BCMH providers. the doctor Ashleigh is seeing is not one of them. Which means they would not cover any of her care if she continued to go to him. stinks!
So i called our insurance company to see if i could get an idea on how much they would cover of her surgery and hospital stay. They said that the type of surgery she is having has to be pre-approved and considered a medical necessity. If it is pre-approved they would cover 90% of the care up to $10,000 and then 100% after the initial $10,000. She said the care would include the surgery, inpatient, labs, ect.
First question: Has anyone had their insurance company deny the fusion surgery? If so what was the degree of your curves. And if they later approved it what were your curve degrees then. I'm just worried about the insurance co saying her curves aren't bad enough.
2nd question is about Shriners. I know that you don't have to pay any money. But how does that work. Do they go through insurance companies and just pick up what the insurance won't cover, or do they not work with insurance companies. If the insurance company says 'no' to the surgery. Does that mean Shriners won't do the surgery, until the insurance co, approves it.
Christina mom to 4 girls. Ashleigh-13 Scoliosis (3 curves C-20/30deg, T-55deg, L-45deg) & Type 1 diabetes.
So i called our insurance company to see if i could get an idea on how much they would cover of her surgery and hospital stay. They said that the type of surgery she is having has to be pre-approved and considered a medical necessity. If it is pre-approved they would cover 90% of the care up to $10,000 and then 100% after the initial $10,000. She said the care would include the surgery, inpatient, labs, ect.
First question: Has anyone had their insurance company deny the fusion surgery? If so what was the degree of your curves. And if they later approved it what were your curve degrees then. I'm just worried about the insurance co saying her curves aren't bad enough.
2nd question is about Shriners. I know that you don't have to pay any money. But how does that work. Do they go through insurance companies and just pick up what the insurance won't cover, or do they not work with insurance companies. If the insurance company says 'no' to the surgery. Does that mean Shriners won't do the surgery, until the insurance co, approves it.
Christina mom to 4 girls. Ashleigh-13 Scoliosis (3 curves C-20/30deg, T-55deg, L-45deg) & Type 1 diabetes.
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