Dealing with Insurance company denials for orthotics

I am an HR professional searching for solutions for one of my employees whose dependent child has PFFD. The health insurance carrier has denied the shoe lifts for the patient. We are going to start the appeals process since the insurance company policy wording states that, for reasons that are totally beyond me, only patients with a diagnosis of diabetes qualify for shoe lifts, even those who have PFFD. Go figure. I want to know if anyone has had to fight this battle with their insurance carrier and won, and what sort of supporting documentation is available to (hopefully) convince the insurance company that their policy is lacking and should be rewritten, or at least this particular appeal should be approved.

my parents had this problem

my parents had this problem with me and all of the doctors and insurance companys didnt want to deal with us. and than one day my brothers friends dad told my parents about shriners hospital for childern and they were wonderful. they understood about the insurance and took me anyways all shriners hospital for childern will help every child they can and no money had to come out of our pockets. I have had 22 surgerys and they are amazing I would most deff tell ur friend to look into getting her child into shriners hospital for childern.

Re: Dealing with Insuance company denials for orthotics

I'm sorry to hear that. If the difference is a few inches sometimes a regular shoe replacement store will have the same material and can do the same thing.

We got our very first prosthetic device and went on a trip to see relatives. It turned out a shoe lift would have been better so we went into a local shoe repair store to see how much it would cost to add a lift to the bottom of a high-top shoe. It cost $35 which was about a factor of 14 less than our co-pay for the first prosthetic and worked better too.

Appeal

The family needs to appeal & contact the state insurance commission. If prosthetics & orthotics are covered, then this should be covered too. Obviously the insurance may noy be understanding the condition. I have never heard of lifts not being covered except in cases where the policy is a catastrophic policy rather than a standard insurance.

shoe lift

I'm sorry to hear that the insurance company is giving you problems.

My daughter's shoe lifts have been covered in part by our insurance. We just need to supply a script from the doctor. We have Aetna.

Beth

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