I was looking into how much braces and AFOs to fit the braces are going to cost. I'm assuming that I'll only need to buy 1 adjustable brace but in the future will need to get new AFOs fitted as my son grows right?
Does anyone know how often this really needs to be done and if I'm going to be charged $200+ every time? I can't get a clear answer from my insurance if any of this is covered. Also, I'm going to be switching insurance providers soon. Does anyone know if clubfoot is considered a preexisting condition and therefore not covered?
Thanks,
Danielle
I can say that our insurance company has paid for everything so far with no problems. I have heard that it can depend on the codes used to when submitted to the insurance. My son is 18 months and we have only had 2 pairs of shoes so far and one bar. But when they measured last time I remember that the guy used his finger to make his foot impression bigger so we wouldn't have to reorder so soon. However when we got the new ones they were really big and we had to make some adjustments to get it to work but in the end it worked. This next time we order I think we will also have to get a new bar but I think there are only 2 sizes of bar so we won't have to get another one after that. I do not believe that it is considered a preexisting condition. I know of other people that have switched insurances and have not had a problem. You man also want to check out the support group on yahoo there are alot of very helpful people there as well.
My son has had "adjustments" to his feet since a couple weeks old. He is now on his second pair of shoes at 9 months old. They need to be changed out when the toes begin to hang off the front edge of the shoe...so the number of shoes needed varies according to each child and that child's rate of growth.
Insurance has covered the cost of everything for us. My hubby has BCBS and put our son on while sitting in the hospital after his birth. His rep told him to be certain he was added permanently as quickly as possible since BCBS would look at it as pre-existing conditions if he allowed Noah to be placed on their newborn temporary coverage and then added him later.
I hope this doesn't happen to you-I see that others have transferred insurances without any problems. Good Luck!
We've had several sets of AFO's because my son is so tall and his feet are growing with him (which is good), but hits the pocketbook hard. Our insurance pays for AFOs once every 6 months and sometimes he'd grow faster than that even if our prosthetist made the foot impression bigger. Soooooo we footed the bill for over half our 8 pairs of AFOs. You have to work your insurance over pretty hard sometimes, too. Correct diagnosis and billing codes are super important and not always the same from ins. company to ins. company.
I figured that on average our out-of-pocket was $200 per pair, but keep in mind that some pairs we only had to pay a co-pay of $20 and others we had to pay the full $700. Take it one pair at a time is all I can say. And never underestimate the worth of a properly fitted brace. If you need assistance, Shriner's Orthopedic Hospitals has a program that can help....I'd have to get the details from my friend Sherry, though. Let me know if you'd like me to contact her and get that info.
- Danielle1234
on Nov. 10, 2008 at 3:37 PM