Does anyone out there have PacifiCare (or United Health) and did you have a hard time getting them to pay for your child's TLSO brace? They have denied Mackenzie's brace saying that orthotics are not a covered service. I have explained that it is a back brace for scoliosis (and it was coded by the brace company as CPT L1200 which is the correct code for a TLSO brace). But Pacificare keeps saying that orthotics are not a covered service. I have reviewed the Summary of Benefits and it never mentions orthotics in either the covered or excluded services.
If you have had this situation, I'd love to hear how you resolved it. We have the PPO product (not the HMO). I am so frustrated with them. I have talked to them 3 times and each time they tell me they will resubmit the claim - only to have it denied again. The bill is nearly $2400!
Any help would be greatly appreciated!!!
Lisa
If you have had this situation, I'd love to hear how you resolved it. We have the PPO product (not the HMO). I am so frustrated with them. I have talked to them 3 times and each time they tell me they will resubmit the claim - only to have it denied again. The bill is nearly $2400!
Any help would be greatly appreciated!!!
Lisa
Comment