Re: re: another insurance quandry

[Guest guest]

Hi all. Hope everyone had a terrific holiday. Now I am back to working on this letter and I have a friend helping me write it who is a professional writer. Anyway, he keeps coming back to the issue that the insurance company presented in the appeal denial letter, that they need some documentation of functional impairment to prove that this tx was not cosmetic. Well, aside from the tort, I know of no functional impairment. Just the concept that we were trying to prevent functional impairment. This friend of mine keeps telling me that I need to come up with some functional impairment documentation. I repeatedly explain that to my knowledge there was none except for the tort, which the plagio did not cause; in fact, the tort contributed to the plagio. She had facial asymetry, flattening of her forehead on the side, tort and plagio and that is all I can document. Anyway, does anyone know of, or have any medical articles that show the long term effects of untreated, moderate to severe plagio. I have about 50 articles but none really state any hard evidence that if left untreated, one could possibly have impairment. What angle should we take? (a my wits end)

[Guest guest]

,

I did not have a lot of luck finding any definitive articles that stated the

long term medical complications that could arise from untreated plagio. I did

find a number of articles that pointed to what the preliminary research says

COULD be the long term medical complications. I used those articles as well

as two letters of medical necessity from the nuero and one letter of medical

necessity from my ped. None of this worked. Finally, my claim was approved

when my case was sent to an external review board who ruled that the

treatment was medically necessary. Sorry that I can't be of too much help.

Have you checked our files sections for appeal letter samples and article

links? Good luck.

Marci (Mom to )

Oklahoma

[Guest guest]

In a message dated 12/30/01 1:11:08 PM Pacific Standard Time, marcisch@... writes:

Sorry that I can't be of too much help.

You are alot of help. You confirm that my research is complete. I have articles that are not even in the files section that I obtained from the hospital library that will help I'm sure. I have done everything. If this 2nd level appeal gets denied, we are going to get an independent review too. Thank you so much. I am getting so frustrated and your response helps. Sincerely,

[Guest guest]

In a message dated 12/30/01 5:00:14 PM Pacific Standard Time, dj2kirby@... writes:

:

It sounds like you have done a ton of research on plagio for your insuarcne appeal. I really hope it helps & the insurance co. will pay like they should.

Good luck - let us know how it ends up.

Oh thanks so much. I appreciate it and I will DEFINITELY let you know and will get my articles in the files if they prove to be helpful. jenny

[Guest guest]

:

It sounds like you have done a ton of research on plagio for your

insuarcne appeal. I really hope it helps & the insurance co. will pay

like they should.

Good luck - let us know how it ends up.

Debbie Abby's mom DOCGrad

MI

HAPPY NEW YEAR!

> In a message dated 12/30/01 1:11:08 PM Pacific Standard Time,

> marcisch@a... writes:

>

>

> > Sorry that I can't be of too much help.

> >

>

> You are alot of help. You confirm that my research is complete. I

have

> articles that are not even in the files section that I obtained

from the

> hospital library that will help I'm sure. I have done

everything. If this

> 2nd level appeal gets denied, we are going to get an independent

review too.

> Thank you so much. I am getting so frustrated and your response

helps.

> Sincerely,

[Guest guest]

Hey jenny can you scan those articles into the computer and send them to me????

Beck

[Guest guest]

In a message dated 12/31/01 12:27:44 PM Pacific Standard Time, bbbhand@... writes:

Hey jenny can you scan those articles into the computer and send them to me????

I would be glad to. The guy who is helping me witht he letter has them right now but whenI get them back I will do it. Jen

[Guest guest]

Great thanks for responding so quickly.

Beck

if it is easier to mail them I can send you money for photocopying and postage just let me know.

[Guest guest]

In a message dated 12/31/01 1:06:00 PM Pacific Standard Time, bbbhand@... writes:

is easier to mail them I can send you money for photocopying and postage

It might be easier to mail them but certainly I can pay for postage. I maybe exaggerated a bit when I said that I have 50 articles but I know I have about 15 or so. Gosh, I have lost track and Joe has them all. I have a photocopier here so it is no big deal. I intend to get them into the files section of the group if they prove to be effective. It might take some time for the insurance company to review the2nd appeal and I still have a few days before I have to mail the letter. Jen

[Guest guest]

Hi - We are fighting CIGNA too, could you please send the letters to me too? Thanks-

talia11624@... wrote: In a message dated 12/31/01 12:27:44 PM Pacific Standard Time, bbbhand@... writes:

Hey jenny can you scan those articles into the computer and send them to me???? I would be glad to. The guy who is helping me witht he letter has them right now but whenI get them back I will do it. Jen For more plagio info

[Guest guest]

In a message dated 12/31/01 3:32:03 PM Pacific Standard Time, owensmom42@... writes:

- We are fighting CIGNA too, could you please send the letters to me too? Thanks-

You bet. I am fighting Fortis but if the articles work it doesn't matter. I don't have them in my possession right now but when I get them back, I will either make copies or get them into the files if I can figure out how. hee hee

[Guest guest]

In a message dated 1/3/02 8:17:04 AM Pacific Standard Time, rocio991@... writes:

Hi and , my name is Fabi and I just got my second appeal with Cigna denied, this whole insurance process is frustating and any help from you will be greatly appreciated, I had my Dr. sent some articles to Cigna and a very good letter and i had high hopes for the 2nd appeal but Cigna still denying coverage "not proven experimental technology" it claims...If you have any info that can help please let

I have a bad feeling that my 2nd appeal will be denied too. I intend to get an independant medical review if that happens. This is such a frustrating experience. It is terrible that we 'lay' people have to muddle our way through this. If our doctors write a letter of medical necessity that should be enough for our insurance companies. It really * & ))*) & ^'s me off. Pardon me but I am growing weary from all of this research, much of which makes little sense to me (and I am in health care so I have some basic medical knowledge). When I get my articles back in the next few weeks (maybe 2 weeks) I will post that I have them back and those who are interested can let me know OR I can attempt to get them in the files. Jen

[Guest guest]

Hey just jumping in here regarding insurance. I actually work for my insurance company and they told me it would ge a cold day in $%** before they would cover it. They said it was considered cosmetic and even read me the section that their reps are given to read out stating that due to congenital torticollis causing plagiocephaly that it was a cosmetic issue. I asked if I could appeal and they said go ahead but didn't seem to think it would make much difference which is frustrating because another lady I worked with wanted a boob job that they said was cosmetic but then they went ahead and changed their mind and covered it because she was uncomfortable? The guy in charge of claims acted like I was insane for even caring about my baby and said "how can they even do PT on a baby?" Thanks

[Guest guest]

In a message dated 1/3/2002 12:24:21 PM Eastern Standard Time, hags1@... writes:

The guy in charge of claims acted like I was insane for even caring about my baby and said "how can they even do PT on a baby?"

Please educate him for us - he needs to educate himself before making any stupid comments about something he has no clue about. Does he think that babies are just globs of flesh that have no nerve endings, no muscular structure, no reflexes?

And he works in claims? No wonder the insurance companies are worthless!

' Mom

[Guest guest]

In a message dated 1/3/02 9:24:17 AM Pacific Standard Time, hags1@... writes:

.. I actually work for my insurance company and they told me it would ge a cold day in $%** before

which insurance company is it? Jen

[Guest guest]

In a message dated 1/3/02 9:24:17 AM Pacific Standard Time, hags1@... writes:

Subj:Re: re: another insurance quandry

Date:1/3/02 9:24:17 AM Pacific Standard Time

From: hags1@...

Reply-to: Plagiocephaly

Plagiocephaly

Hey just jumping in here regarding insurance. I actually work for my insurance company and they told me it would ge a cold day in $%** before they would cover it. They said it was considered cosmetic and even read me the section that their reps are given to read out stating that due to congenital torticollis causing plagiocephaly that it was a cosmetic issue. I asked if I could appeal and they said go ahead but didn't seem to think it would make much difference which is frustrating because another lady I worked with wanted a boob job that they said was cosmetic but then they went ahead and changed their mind and covered it because she was uncomfortable? The guy in charge of claims acted like I was insane for even caring about my baby and said "how can they even do PT on a baby?" Thanks

Oh that's nice. Jen

[Guest guest]

Ooh I don't know if I should said in case they could track me down and know what I have said about them! But it is a quite well known company. Thanks

[Guest guest]

Yes it was quite discouraging especially knowing that if they treat the employees that way I know how they must treat the general public!

[Guest guest]

Yes I tried to explain the whole thing to him and he kept saying "what is it called again?" and "why would they try PT on a baby?" I felt like beating my head on the wall after speaking with him. I am sure with me bugging him and appealing he will be educated in the end!! But I found it interesting that in their literature to tell to subscribers that it listed word for word the tort and the plagio as a result. -

[Guest guest]

Yes from what I can gather this is the way to go! I guess if I told them my baby wanted a boob job they would be more likely to cover it then her tort and plagio!! -- and Gracie

[Guest guest]

and Jen and everyone else appealing- we will keep you in our thoughts- this must be so frustrating for you. beck

[Guest guest]

This is all so true and what I fear is that if I ever have to switch insurances will this be considered pre exsisting and another insurance company maybe won't cover the treatment that Grace needs (PT, etc) --

[Guest guest]

> Hi and , my name is Fabi and I just got my second appeal

with Cigna denied, this whole insurance process is frustating and any

help from you will be greatly appreciated, I had my Dr. sent some

articles to Cigna and a very good letter and i had high hopes for the

2nd appeal but Cigna still denying coverage " not proven experimental

technology " it claims...If you have any info that can help please let

me know, thanks.

>

> > - We are fighting CIGNA too, could you please send the

letters to me

> > too? Thanks-

>

> You bet. I am fighting Fortis but if the articles work it doesn't

matter. I

> don't have them in my possession right now but when I get them

back, I will

> either make copies or get them into the files if I can figure out

how. hee

> hee

[Guest guest]

In a message dated 1/3/02 11:39:29 AM Pacific Standard Time, bbbhand@... writes:

and Jen and everyone else appealing- we will keep you in our thoughts- this must be so frustrating for you. beck

thank you. Jen

[Guest guest]

In a message dated 1/3/02 11:10:06 AM Pacific Standard Time, hags1@... writes:

Yes from what I can gather this is the way to go! I guess if I told them my baby wanted a boob job they would be more likely to cover it then her tort and plagio!!

It is funny you should say that because in our letter we are going to add that it isn't like we are wanting to have a breast augmentation.....we are talking about her future health. My hubby isn't sure we should say that but I think it is funny. Jen