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Cerebral Palsy Message Board
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Old 01-15-2009, 06:28 PM   #1
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Location: VA
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LadyPanther HB User
I really need some help!

Okay, back in Oct, we got a prescription from the neurologist for a Mclaren special needs pushchair (stroller) It was delivered from a rehab place in our area and we paid them the 10% co-pay and our insurance covered the rest, or so we thought...
Today we get a call from the rehab place saying our insurance, Blue cross, won't cover this without a letter of medical necessity and even then, they might reject it. The dx is wrote on script as brain injury (HIE) and spastic diplegic cerebral palsy.
The place told us after knowing 2 months the insurance rejected this that we either have to get them to cover it or pay $1200 for a stroller we could have bought outright on the internet for $500 or even direct from the company for $700!
What do we do? We don't have $1200 to pay for this and we told the rehab place NOT to order this until it was approved by insurance in the first place.
We looked at the fine print on the receipt we signed and it says if insurance doesn't cover it in 60 days, we have to pay it in full!
Any thougths about what to do would be appreciated.

 
Old 01-15-2009, 09:13 PM   #2
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Posts: 240
Malwm01 HB User
Re: I really need some help!

Quote:
Originally Posted by LadyPanther View Post
Okay, back in Oct, we got a prescription from the neurologist for a Mclaren special needs pushchair (stroller) It was delivered from a rehab place in our area and we paid them the 10% co-pay and our insurance covered the rest, or so we thought...
Today we get a call from the rehab place saying our insurance, Blue cross, won't cover this without a letter of medical necessity and even then, they might reject it. The dx is wrote on script as brain injury (HIE) and spastic diplegic cerebral palsy.
The place told us after knowing 2 months the insurance rejected this that we either have to get them to cover it or pay $1200 for a stroller we could have bought outright on the internet for $500 or even direct from the company for $700!
What do we do? We don't have $1200 to pay for this and we told the rehab place NOT to order this until it was approved by insurance in the first place.
We looked at the fine print on the receipt we signed and it says if insurance doesn't cover it in 60 days, we have to pay it in full!
Any thougths about what to do would be appreciated.

Well, and this was just my first thought (and it might not even be a good one) but could you borrow the money from someone and buy a brand new Maclaren ($500-$700 whatever it ends up being) and return the brand new unused chair to the rehab place??? So they have to give you your 10% back and they can't pursue you for the $1,200?

Like I said, that was just my initial thought on it all... good luck!! I hope something works for you.

 
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Old 01-16-2009, 09:33 AM   #3
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Steffers2318 HB User
Re: I really need some help!

Hmpf, seems kinda fishy to me...you specifically asked them to make sure your insurance would approve it first, but it doesn't seem like they did, or else they would have told you about the need for the letter at the beginning of the 60 days, right? (Did they tell you when you signed and paid the co-pay that they had OK'd everything?? Or did you make the "don't order it until..." stipulation after?) To me it sounds like they purposely waited until 60 days was up, THEN contacted your insurance, because they knew they had the loophole in place in the fine print. Plus, it seems like a ripoff if you can get it for so much less elsewhere...they probably know that insurances won't pay for it when the price is so inflated, so they try to make sure they get the high payment from someone (the customer). UNLESS the price difference is employee payment added on...

I'm definately no expert or anything, but here's what I would do: 1). Contact the doctor who gave you the script, explain the situation, and ask for the letter ASAP; 2). Call your insurance company, explain the situation, and ask them when they were contacted by the rehab company. If the person says not until recently, make sure to get his/her name/number and let him/her know you may be calling again; 3). Depending on the answer to 2, and also when you asked them to contact your insurance first, call the rehab company back and explain that they violated the verbal agreement they had with you, so they need to give you your copay and take the chair back or you will be contacting the Better Business Bureau and a lawyer (you can then get the chair direct or from the internet).

HOWEVER, if you asked them to OK it with insurance first after you signed the contract, they could argue that that wasn't part of your agreement. Although if they agreed to do it, I would say you could still use that to negotiate with them. On the other hand, just because you didn't read the fine print does not mean you didn't legally agree to pay after 60 days, if you get what I mean. It's an iffy situation.

So, just try to get your insurance to cover it first, and if they won't, contact a lawyer and, if need be, take the rehab company to civil court or Judge Judy or something like that (I see stuff like this on there all the time)!

Good Luck! Let me know what you find out and what happens!

 
Old 01-16-2009, 10:58 AM   #4
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Join Date: Dec 2008
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LadyPanther HB User
Re: I really need some help!

We thought it was covered back when they delivered it and collected the co-pay since we made it very clear NOT to order it until it cleared with the insurance!

Last edited by LadyPanther; 01-17-2009 at 04:57 AM.

 
Old 01-16-2009, 11:34 AM   #5
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LandonsMommy05 HB User
Re: I really need some help!

My dear, you are in a baaad prediciment. I don't really know what to say except that if it were me, I'd call the insurance company and the neurologist. I don't really know where to go from there.

 
Old 01-16-2009, 12:23 PM   #6
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Join Date: Dec 2008
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LadyPanther HB User
Re: I really need some help!

We called the insurance company and they told us it's the rehabs place responsibility to obtain the letter and get this covered, not ours since they are a preferred provider. They said we are not financially responsible if they don't do what they are supposed to do to get approval.

 
Old 01-20-2009, 09:02 AM   #7
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LandonsMommy05 HB User
Re: I really need some help!

Well thank goodness for that! Hope everything turns out okay.

 
Old 01-24-2009, 08:14 AM   #8
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Location: Pittsburgh, Pennsylvania
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Steffers2318 HB User
Re: I really need some help!

Good... then I don't really think you have to worry; just call the rehab place and let them know you talked to your insurance and that you're "on to" what they're trying to do, and it should work out fine!

 
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