A Parenting & kids forum. ParentingBanter.com

If this is your first visit, be sure to check out the FAQ by clicking the link above. You may have to register before you can post: click the register link above to proceed. To start viewing messages, select the forum that you want to visit from the selection below.

Go Back   Home » ParentingBanter.com forum » misc.kids » Breastfeeding
Site Map Home Authors List Search Today's Posts Mark Forums Read Web Partners

Breastfeeding not medically necessary



 
 
Thread Tools Display Modes
  #21  
Old June 29th 06, 06:49 PM posted to misc.kids.breastfeeding
external usenet poster
 
Posts: n/a
Default Breastfeeding not medically necessary


Pologirl wrote:
Well, that sucks big time.

How about a different approach? Such as: medically necessary to
rescue normal function of the milk ducts. Breastfeeding evidently is
not medically necessary for your baby, because she is thriving on
formula. But normally functioning milk ducts may be medically
necessary for you: prevention of mastitis and other direct effects of
the blockage; indirect effects such as lower risk of breast cancer,
etc. Those reasons might add up to a stronger case for medical
necessity.


I agree with you, this seems to be a less controversial approach...
I'm going to try that!

  #22  
Old June 29th 06, 08:56 PM posted to misc.kids.breastfeeding
external usenet poster
 
Posts: n/a
Default Breastfeeding not medically necessary


There is another possibility: that the claim was denied simply because
the particular code used by the surgeon's billing specialist is one not
recognized among the set of codes that are pre-approved as indicating
"medical necessity" within the surgeon's specialty. To deal with this
angle, you have two approaches. 1. Discuss with the billing person
the code(s) actually applied to your claim, and what other codes might
apply. 2. Request the insurance company to review your case.

But before you do anything, it might help to "get your head around" the
whole concept of "medical necessity". Eg:
http://www.aph.gov.au/Library/pubs/R...-01/01RP23.htm

Wanting to breastfeed is why you care about normal function, but the
ability to breastfeed in itself is not a compelling medical reason.
Restoring normal function usually *is* a compelling medical reason.

  #23  
Old June 30th 06, 02:29 AM posted to misc.kids.breastfeeding
external usenet poster
 
Posts: n/a
Default Breastfeeding not medically necessary


Lady Penelope Creighton-Ward wrote:
Pologirl wrote:
There is another possibility: that the claim was denied simply because
the particular code used by the surgeon's billing specialist is one not
recognized among the set of codes that are pre-approved as indicating
"medical necessity" within the surgeon's specialty. To deal with this
angle, you have two approaches. 1. Discuss with the billing person
the code(s) actually applied to your claim, and what other codes might
apply. 2. Request the insurance company to review your case.

But before you do anything, it might help to "get your head around" the
whole concept of "medical necessity". Eg:
http://www.aph.gov.au/Library/pubs/R...-01/01RP23.htm

Wanting to breastfeed is why you care about normal function, but the
ability to breastfeed in itself is not a compelling medical reason.
Restoring normal function usually *is* a compelling medical reason.


This is extremely helpful information, thank you so much!


Some googling that might be helpful:

keywords: Massachusetts, HMO, "medically necessary," denial

This will bring up, at the least, the contacts (pre-legal) for pursing
an appeal. Additionally, other cases brought up will indicate law firms
that have been involved. (Including a pamphlet from the AG's office)

Agh. This is so tremendously frustrating. Please keep us posted.

Caledonia

  #24  
Old July 2nd 06, 03:02 PM posted to misc.kids.breastfeeding
external usenet poster
 
Posts: n/a
Default Breastfeeding not medically necessary

Beth Kevles wrote:
Hi --

Escalate! If the insurance company fails to give satisfaction, your
next step is your state's overseer of medical insurance companies. If
THAT fails then I'd start writing to newspapers, etc, but hopefully
this will succeed at the state level.

Be sure to include, in your missive to the state commissioner (or
whatever) information about health benefits to mother and child.


On top of that, I'd find out if your state has a medical society, and if so
try contacting their "government affairs" division, if they have one (which
they probably would). They might lobby your state's legislators to change
the laws so that insurance companies would not be allowed to second-guess
your physician's judgment on the medical necessity of doing a surgery that
allows you to bf.

--
Belphoebe


  #25  
Old July 2nd 06, 03:15 PM posted to misc.kids.breastfeeding
external usenet poster
 
Posts: n/a
Default Breastfeeding not medically necessary

Belphoebe wrote:
Beth Kevles wrote:
Hi --

Escalate! If the insurance company fails to give satisfaction, your
next step is your state's overseer of medical insurance companies.
If THAT fails then I'd start writing to newspapers, etc, but
hopefully this will succeed at the state level.

Be sure to include, in your missive to the state commissioner (or
whatever) information about health benefits to mother and child.


On top of that, I'd find out if your state has a medical society, and
if so try contacting their "government affairs" division, if they
have one (which they probably would). They might lobby your state's
legislators to change the laws so that insurance companies would not
be allowed to second-guess your physician's judgment on the medical
necessity of doing a surgery that allows you to bf.


Following up on my own post, I noticed Caledonia mentioned Boston, MA in her
reply to you. Here's contact information for the Massachusetts Medical
Society:

Massachusetts Medical Society
860 Winter Street
Waltham MA 02451
(800) 322-2303 or (781) 893-4610

Their web address: http://www.massmed.org//AM/Template.cfm?Section=Home

--
Belphoebe


  #26  
Old July 6th 06, 06:19 AM posted to misc.kids.breastfeeding
Lady Penelope Creighton-Ward
external usenet poster
 
Posts: 190
Default Breastfeeding not medically necessary


Belphoebe wrote:
Belphoebe wrote:
Beth Kevles wrote:
Hi --

Escalate! If the insurance company fails to give satisfaction, your
next step is your state's overseer of medical insurance companies.
If THAT fails then I'd start writing to newspapers, etc, but
hopefully this will succeed at the state level.

Be sure to include, in your missive to the state commissioner (or
whatever) information about health benefits to mother and child.


On top of that, I'd find out if your state has a medical society, and
if so try contacting their "government affairs" division, if they
have one (which they probably would). They might lobby your state's
legislators to change the laws so that insurance companies would not
be allowed to second-guess your physician's judgment on the medical
necessity of doing a surgery that allows you to bf.


Following up on my own post, I noticed Caledonia mentioned Boston, MA in her
reply to you. Here's contact information for the Massachusetts Medical
Society:

Massachusetts Medical Society
860 Winter Street
Waltham MA 02451
(800) 322-2303 or (781) 893-4610

Their web address: http://www.massmed.org//AM/Template.cfm?Section=Home

--
Belphoebe


Thank you so much, Belphoebe.

The current status is that the breast specialist's nurse has spoken
with the peer reviewer from the insurance company, and I am awaiting
their new decision. The nurse said the doctor would be happy to speak
with them if necessary, but for now this was all that was needed.

I should be hearing back from CIGNA within 15 business days.

 




Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

vB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Forum Jump

Similar Threads
Thread Thread Starter Forum Replies Last Post
misc.kids FAQ on Breastfeeding Past the First Year [email protected] Info and FAQ's 0 August 30th 05 05:25 AM
misc.kids FAQ on Breastfeeding Past the First Year [email protected] Info and FAQ's 0 June 28th 04 07:41 PM
misc.kids FAQ on Breastfeeding Past the First Year [email protected] Info and FAQ's 0 April 17th 04 12:24 PM
New articles about bfing Chookie Breastfeeding 2 December 18th 03 11:30 AM
Recent Articles of Interest (Support-related) Chookie Breastfeeding 0 November 1st 03 12:53 PM


All times are GMT +1. The time now is 02:11 PM.


Powered by vBulletin® Version 3.6.4
Copyright ©2000 - 2024, Jelsoft Enterprises Ltd.
Copyright ©2004-2024 ParentingBanter.com.
The comments are property of their posters.