Re: UHC Denied our Appeal - Angry beyond belief!

[Guest guest]

Jaya,

Yes, the insurance department is supposed to protect the consumers!! If there

is any gray area in your case at all they are supposed to rule for the

insured NOT the insurance company.

I really understand your frustration and I am going through the EXACT same

thing. However, my insurance company denied based on cosmetic until the VERY

last appeal at which time they came back with the not FDA approved thing!!!

BAD FAITH and I will not quit without the fight of a lifetime!!!!! We're

doing the external review, but I will take them to small claims court if that

does not work.

Marci

[Guest guest]

Jaya,

This is an awful situation that the ins. co has put you in. I am

certainly no expert but I would think that you need to shake them up

from the outside. You are right they will just keep this

tied up in house forever. Sometimes all it takes is to let them know

that you aren't going to roll over and play dead. What if you

contacted a news station as one of the other mothers did? Also maybe

even just having a letter drawn up by an attourney may do the trick.

It will cost them a lot less in the long run to just pay the claim

than to pay legal fees too. Esp. where you have documented everything

so well. Good Luck.

Congrats to i just in time for the nice weather.

April

Mommy to Bri and Mandy

> Hello All,

>

> We we finally got our response to our Appeal and big surprise, UHC

> has denied it!!

>

> In the orginal letter that we recieved from them, they told us that

> if i had been born with Plagio - they would have paid. Of the

> MANY things that we supplied them, we also supplied them photos of

> when i was born, compared to when se was 5 months old. She had

> the EXACT same head shape 5 months after she was born as she did the

> day she was born!! UHC didn't even respond to the pictures, they

> totally ignored the fact that they were even submitted!

>

> They further stated that we have prove that i has a functional

> impairment that will be corrected by the DOC

Band...........obviously

> they are getting better with their denials because they know darn

> well there are no functional impairments RIGHT NOW - they occur

later

> in life!

>

> But anway I plan to go down fighting! I can't even believe that in

> the beginning (I have it writing!!) they stated if she were born

with

> Plagio they would pay - but they ignored the proof that we gave to

> them!!

>

> They say that I can either do another internal appeal or go

> externally......what do you folks think? I am pretty certain

staying

> in house will be a waste, since they are so obviously predjudice

> against our case, but I am not sure if going out side would be any

> better.........any suggestions from the lawyers on the board??

>

> Well thanks for listening and I apologize for the rant. Well the

> good news is, we go for i's exit casting today!! )

>

> Sincerely,

> Jaya Dong

> mom to i - DOC Graduate TODAY!!!!

[Guest guest]

Jaya

It is just a long shot but the majority of plagio babies are a result of

interuterine compression syndrome, did you have fibroids or is your womb

particulary small

pre-natal scans would have shown something that way you could prove that your

little one was compressed inutero therefore she would have been born with

plagio

Also in the UK people would contact there Member of Parliamrnt and take it up

with them I imagine you have done that

Ann (UK)

[Guest guest]

Hello All,

I just read further about the external appeal - the appeal would go

to the NY State Insurance Department. I am assuming that these guys

must be the Insurance watch dogs, but I am uncertain.

Has anyone had any luck going to this level of appeal?? They are

supposed to be a non-partial and non-biased, but I am not exactly in

a trusting frame of mind anymore.....especially since UHC told me

they would be more then happy to cover all costs if we decided to

have surgery! Can you believe that? They would rather put my

daughter through surgery then pay for a MUCH cheaper non-evasive

means of treatment! Grrrrrrrrrrrrrr.

Thank you for any input!

Sincerely,

Jaya Dong

Mom to i - DOC Band Graduate TODAY!!!!

> Hello All,

>

> We we finally got our response to our Appeal and big surprise, UHC

> has denied it!!

>

> In the orginal letter that we recieved from them, they told us that

> if i had been born with Plagio - they would have paid. Of the

> MANY things that we supplied them, we also supplied them photos of

> when i was born, compared to when se was 5 months old. She had

> the EXACT same head shape 5 months after she was born as she did

the

> day she was born!! UHC didn't even respond to the pictures, they

> totally ignored the fact that they were even submitted!

>

> They further stated that we have prove that i has a functional

> impairment that will be corrected by the DOC

Band...........obviously

> they are getting better with their denials because they know darn

> well there are no functional impairments RIGHT NOW - they occur

later

> in life!

>

> But anway I plan to go down fighting! I can't even believe that in

> the beginning (I have it writing!!) they stated if she were born

with

> Plagio they would pay - but they ignored the proof that we gave to

> them!!

>

> They say that I can either do another internal appeal or go

> externally......what do you folks think? I am pretty certain

staying

> in house will be a waste, since they are so obviously predjudice

> against our case, but I am not sure if going out side would be any

> better.........any suggestions from the lawyers on the board??

>

> Well thanks for listening and I apologize for the rant. Well the

> good news is, we go for i's exit casting today!! )

>

> Sincerely,

> Jaya Dong

> mom to i - DOC Graduate TODAY!!!!

[Guest guest]

Hey, I also had/or still have a small fibroid!

HHHHMMMMMMM?

Jill

--- Jaya Dong <angandjaya@...> wrote:

> Ann,

>

> THANK YOU!! I realized after I read your post that

> I never submitted

> a letter documenting the fibroid that I had when I

> was pregnant with

> i. They found the fibroid right in the

> beginning of the

> pregnancy, but told me not to worry about it because

> it wouldn't do

> any damage and was only the size of a grape. The

> more I think about

> it the more I realize it could have been a case of

> the " Princess and

> the Pea " and caused i to shift around and

> confine her own quaters

> so that she wouldn't be resting against it.

> Hmmmmmm, I don't know if

> having documentation of the fibroid will help, but

> it certainly can't

> hurt so I will call the OB/GYN and have him write a

> letter for me to

> submit with the exteranl appeal.

>

> Thank you for the suggestion!! I can't believe I

> forgot about the

> fibroid that I have/had!!

>

> Sincerely,

> Jaya Dong

>

>

>

>

> > Jaya

> >

> > It is just a long shot but the majority of plagio

> babies are a

> result of

> > interuterine compression syndrome, did you have

> fibroids or is your

> womb

> > particulary small

> > pre-natal scans would have shown something that

> way you could prove

> that your

> > little one was compressed inutero therefore she

> would have been

> born with

> > plagio

> >

> > Also in the UK people would contact there Member

> of Parliamrnt and

> take it up

> > with them I imagine you have done that

> >

> > Ann (UK)

>

>

__________________________________________________

[Guest guest]

Jaya

What is important is that all fibroids start off smaller at the begining of

the pregnancy but they grow due to increased oestrogen levels mine started

off 1.5cm and grew to 7cm the position of the fibroid is important posterior

wall etc

The peadiatricians here are convinced the fibroid caused Boo to be stuck in

one position as he grew

Did you have more than one scan they would have measured the fibroid and

logged the location also scan pictures would show your little ones position

Ann(UK)

[Guest guest]

Hello

What is very interesting is that as older mums (I know moms) we are more

prone to fibroids perhaps we are onto something girls.....maybe we should all

submit our fibroids to Jaya's appeal

Ann (UK)

[Guest guest]

Jaya,

Let me know if the fibroid thing works for you. I had two fibroids when I was

pregnant with . One was the size of a grapefruit and one was the size of

a lemon. I never actually thought about it being a factor, but I agree that

it sure could be!!!!

Marci

[Guest guest]

Hey,

I had a fibroid that grew during my pregnancy. Hunter did not move the

last two months of my pregnancy. The fibroid pressed on Hunter's head; the

doctor said that the fibroid was larger than a grapefruit. Our doctors now

say that the plagiocephaly is definetly the result from the fibroid growing

and pressing on Hunter's head.

Thanks, Amy White Hunter's mother

[Guest guest]

Amy,

I also had a large fibroid (the size of a bowling ball) but my son was

born with a round head. But by 6 weeks old I started to notice a flattening

on the side of his head. I am wondering if he was predispositioned to

" Plagio. " as a result of the fibroid. If my son was not able to move

properly in the womb, would this lead to a weakened area of the skull? Thus

making it easier for the bones to move out of alignment. I am curious was

your child born with a round head?

[Guest guest]

I do not know if Hunter was actually born with a round head at birth. We

were just so glad he was healthy at birth; he was born at 37 weeks, the

doctors were afraid that the lungs would not be developed. He did have a bad

case of jaundice; so we concentrated on that for a while. We first noticed

his head problem at four weeks old when he would only lay in one direction

and we started to realize that his head was bigger on one side than the

other. His ears are misaligned also. Our doctor feels certain it was like

this at birth but we did not catch this.

Thanks, Amy

[Guest guest]

Amy,

Thank you for your responce, and sorry I did not sign it (dope!!). I am

trying to find out if my large fibroid had anything to do with the flatness

of my sons head, or if it was due to placing him on his back so much. We are

meeting with a specialist at Cedars Sinae Hospital this week, and I will ask

him the same question. It just seems odd that so many people on this site

have fibroids, and I can't help but think the fibroid weakens the skull and

predispositions the babies to Plagio.

Dori & 5 mos. old (still being evaluated)