Tuesday, March 16, 2010

Not medically necessary.

Peanut's car seat was denied by both our insurances now. The therapist did the write-up to get a Britax Traveller or whatever it's called. They explained how she doesn't have enough trunk control for a regular booster seat and how when she's tired or has a seizure she needs head control help.

The first insurance said it falls under the guise of the second insurance. The second insurance said it's not medically necessary.

What the f!*#? Seriously. How is it NOT necessary that she be safely restrained in the car during travel? Should she be homebound? Should she be unsafe in the car?

Ugh! I guess I am starting the appeal process now. And we are waiting to hear on her Sleep Safe Bed. I assume there's no chance in hell they'll think THAT is medically necessary, eh?

8 comments:

Lacey said...

Oh my gosh, first of all, why would the primary insurance say it falls under the secondary insurance? Just another thing telling us health care for our children is seriously wrong!

Junior said...

wow, Junior has the Britax special traveler and it was covered by medi-cal without a question.
Do you ever get to the Sacramento/Lodi area? Junior does not use his anymore and would be happy to pass it on. It is just too stinkin heavy and big to try to ship.

The VW's said...

Hope they approve it for you! We had issues with half the equipment that we have for Gavin, but in the end they approved it with appeals and additional information. But, what a pain!

Becky said...

Really? That surprises me. Ben's was covered no problem. Keep fighting!!!

Jenkins said...

Ugh, not fun. We always get the not medicially necessary...then we do the appeal with more letters (PT, peds, neuro). I was recently told that a lot of things are getting denied first go around (to weed out those who might be really need it or be willing to fight).

We just go approved for the Sleep Safe bed which should be here in a few weeks...it was denied the first time, second time we got approved. We had a doctor right specifically to the rails that other hospital like beds have and our child could get limbs stuck in them due to seizures. Insurance would then have to provide seizure pads to protect our child from the rails, which are not a very safe alternative. The Sleep safe sides protect our child the best. The is what won our argument and of course we mentioned all of the others things.

Treguboff Family said...

On no! How crappy is that! I swear the people that sit behind the desks and make the decisions have absolutely no idea. I just had to go through two approvals to get my son's medications increased. Tell me that is not rediculous. I hope Miss Peanut gets her car seat. Fight for it mama!

Alicia said...

No freakin' way!! These people are crooks who had better pray that they or someone they love is never in a situation like this. Not medically necessary?? I hope and pray your appeal goes well and you get these jerks to think before they deny deny deny!

Michelle and Sean said...

That stinks I can't believe it!! It makes no sense. I agree with everyone else. Keep appealing. Thats how we got some of the trip to Boston covered. Boston doctors were on the phone with our insurance company for days trying to get things approved because Maggie needed a nurse to fly with her. They have to give in eventually. I also agree with Lacey. That is something that should be covered by your primary insurance. I'm so sorry they are not working with you. What a pain. I hope the bed gets covered.