Re: Did Cigna HMO pay for your DOC band?

[Guest guest]

Oh Gosh...all this cosmetic " surgery vs. therapy " pertaining to the

AMA Resolution may be my fault. You see, when I composed my appeal

letter, I quoted from the AMA Resolution but added the word THERAPY

in parenthesis. I did submit the actual resolution, with my appeal,

for their review (along with a ton of other information).

Alhough " surgery " is the actual word used in the resolution,

insurance companies are stating that banding therapy is cosmetic in

nature. Since banding is a therapeutic treatment for this

developmental deformity, and does not involve surgery (except when

used after surgery in cases of craniosynostosis), I added the word

therapy for emphasis. I am so sorry for this confusion! (But,

hey...my appeal worked and for that I am ever so grateful!)

Good luck to all of you!

All my best,

Polly and (DOC Band Graduate)

> >

> >

> >

> > [eGroups] My Groups | Plagiocephaly Main Page | Start a

> > new group!

> >

> > :

> >

> > Go to the Files section, and look under insurance/appeals (I can't

> > remember the name of the folder). CIGNA HMO did pay 100% for our

DOC

> > band after one denial, and the appeal letter that is posted in

there

> > (which was actually pieced together towards our case by bits and

> > pieces of other letters - letters Cranial Tech gave us as well as

> > posted here by other successful appeals....) Try to use their

> > language/reason and refute it logically, and to use any and all

causes

> > towards the plagiocephaly (in utero constraint, vacuum extraction,

> > toricollis, etc. with documentation from your pediatrician if

> > possible), and what you've done so far to correct it without the

band

> > (for example, positioning, PT for torticollis, etc. again with

> > documentation either in picture form or from your pediatrician

(for

> > example, the RX for physical Therapy for Tort...) etc.).

> >

> > Good luck!

> > H.

> > -----Original Message-----

> > From: Agahi [mailto:.Agahi@u...]On Behalf Of

> > Agahi

> > Sent: Wednesday, September 20, 2000 9:57 AM

> > Plagiocephalyegroups

> > Subject: Did Cigna HMO pay for your DOC band?

> >

> > Well, We are still fighting with Cigna HMO to pay for my son's DOC

> > band.

> > We started very late. He was 22 months. I just need to know if

Cigna

> > HMO

> > has paid for a DOC band this late or have they every paid for the

DOC

> > band or any information regarding this. I really appreciate you

> > sharing

> > this information in advance.

> >

> > Thanks,

> > Arshi's mom,

> >

> >

[Guest guest]

I think it was understood that the parenthetical/bracketed words were additions to the resolution. At least, to this former English teacher.... *smile*

In any case, the inclusion of the 1997 Craniosysnostosis and Skull Molding Symposium guidelines with the AMA statement really secure the point that orthotic management is a recommended treatment when positioning has not helped, and is not likely to help depending on the head shape...

H.

-----Original Message-----From: Polly Janos [mailto:pollyjanos@...]Sent: Wednesday, October 04, 2000 8:43 AMPlagiocephalyegroupsSubject: Re: Did Cigna HMO pay for your DOC band?Oh Gosh...all this cosmetic "surgery vs. therapy" pertaining to the AMA Resolution may be my fault. You see, when I composed my appeal letter, I quoted from the AMA Resolution but added the word THERAPY in parenthesis. I did submit the actual resolution, with my appeal, for their review (along with a ton of other information). Alhough "surgery" is the actual word used in the resolution, insurance companies are stating that banding therapy is cosmetic in nature. Since banding is a therapeutic treatment for this developmental deformity, and does not involve surgery (except when used after surgery in cases of craniosynostosis), I added the word therapy for emphasis. I am so sorry for this confusion! (But, hey...my appeal worked and for that I am ever so grateful!)Good luck to all of you!All my best,Polly and (DOC Band Graduate)> >> >> >> > [eGroups] My Groups | Plagiocephaly Main Page | Start a> > new group!> >> > :> >> > Go to the Files section, and look under insurance/appeals (I can't> > remember the name of the folder). CIGNA HMO did pay 100% for our DOC> > band after one denial, and the appeal letter that is posted in there> > (which was actually pieced together towards our case by bits and> > pieces of other letters - letters Cranial Tech gave us as well as> > posted here by other successful appeals....) Try to use their> > language/reason and refute it logically, and to use any and all causes> > towards the plagiocephaly (in utero constraint, vacuum extraction,> > toricollis, etc. with documentation from your pediatrician if> > possible), and what you've done so far to correct it without the band> > (for example, positioning, PT for torticollis, etc. again with> > documentation either in picture form or from your pediatrician (for> > example, the RX for physical Therapy for Tort...) etc.).> >> > Good luck!> > H.> > -----Original Message-----> > From: Agahi [mailto:.Agahi@u...]On Behalf Of> > Agahi> > Sent: Wednesday, September 20, 2000 9:57 AM> > Plagiocephalyegroups> > Subject: Did Cigna HMO pay for your DOC band?> >> > Well, We are still fighting with Cigna HMO to pay for my son's DOC> > band.> > We started very late. He was 22 months. I just need to know if Cigna> > HMO> > has paid for a DOC band this late or have they every paid for the DOC> > band or any information regarding this. I really appreciate you> > sharing> > this information in advance.> >> > Thanks,> > Arshi's mom, > >> >

[Guest guest]

Polly,

You said that your appeal was successful. I have a copy of your letter that

I got from Cranial Technologies. Our insurance is also United Healthcare,

so I'm interested in any information you can give me on doing a successful

appeal.

UH has said that if Averie's plagio was caused in utero, it would be a

covered benefit. We had several ultrasounds done and have thought about

trying to use them to show her cranial development. Did UH ever see your

tapes?

lee

>From: " Polly Janos " <pollyjanos@...>

>Reply-Plagiocephalyegroups

>Plagiocephalyegroups

>Subject: Re: Did Cigna HMO pay for your DOC band?

>Date: Wed, 04 Oct 2000 12:43:07 -0000

>

>Oh Gosh...all this cosmetic " surgery vs. therapy " pertaining to the

>AMA Resolution may be my fault. You see, when I composed my appeal

>letter, I quoted from the AMA Resolution but added the word THERAPY

>in parenthesis. I did submit the actual resolution, with my appeal,

>for their review (along with a ton of other information).

>Alhough " surgery " is the actual word used in the resolution,

>insurance companies are stating that banding therapy is cosmetic in

>nature. Since banding is a therapeutic treatment for this

>developmental deformity, and does not involve surgery (except when

>used after surgery in cases of craniosynostosis), I added the word

>therapy for emphasis. I am so sorry for this confusion! (But,

>hey...my appeal worked and for that I am ever so grateful!)

>

>Good luck to all of you!

>

>All my best,

>

>Polly and (DOC Band Graduate)

>

>

> > >

> > >

> > >

> > > [eGroups] My Groups | Plagiocephaly Main Page | Start a

> > > new group!

> > >

> > > :

> > >

> > > Go to the Files section, and look under insurance/appeals (I can't

> > > remember the name of the folder). CIGNA HMO did pay 100% for our

>DOC

> > > band after one denial, and the appeal letter that is posted in

>there

> > > (which was actually pieced together towards our case by bits and

> > > pieces of other letters - letters Cranial Tech gave us as well as

> > > posted here by other successful appeals....) Try to use their

> > > language/reason and refute it logically, and to use any and all

>causes

> > > towards the plagiocephaly (in utero constraint, vacuum extraction,

> > > toricollis, etc. with documentation from your pediatrician if

> > > possible), and what you've done so far to correct it without the

>band

> > > (for example, positioning, PT for torticollis, etc. again with

> > > documentation either in picture form or from your pediatrician

>(for

> > > example, the RX for physical Therapy for Tort...) etc.).

> > >

> > > Good luck!

> > > H.

> > > -----Original Message-----

> > > From: Agahi [mailto:.Agahi@u...]On Behalf Of

> > > Agahi

> > > Sent: Wednesday, September 20, 2000 9:57 AM

> > > Plagiocephalyegroups

> > > Subject: Did Cigna HMO pay for your DOC band?

> > >

> > > Well, We are still fighting with Cigna HMO to pay for my son's DOC

> > > band.

> > > We started very late. He was 22 months. I just need to know if

>Cigna

> > > HMO

> > > has paid for a DOC band this late or have they every paid for the

>DOC

> > > band or any information regarding this. I really appreciate you

> > > sharing

> > > this information in advance.

> > >

> > > Thanks,

> > > Arshi's mom,

> > >

> > >

[Guest guest]

Where can I get a copy of the 1997 Craniosysnostosis and Skull Molding

Symposium guidelines with the AMA statement?

>From: " Kali " <tnt@...>

>Reply-Plagiocephalyegroups

><Plagiocephalyegroups>

>Subject: RE: Re: Did Cigna HMO pay for your DOC band?

>Date: Wed, 4 Oct 2000 22:44:58 -0400

>

>I think it was understood that the parenthetical/bracketed words were

>additions to the resolution. At least, to this former English teacher....

>*smile*

>

>In any case, the inclusion of the 1997 Craniosysnostosis and Skull Molding

>Symposium guidelines with the AMA statement really secure the point that

>orthotic management is a recommended treatment when positioning has not

>helped, and is not likely to help depending on the head shape...

>

> H.

>

>

>

>-----Original Message-----

>From: Polly Janos [mailto:pollyjanos@...]

>Sent: Wednesday, October 04, 2000 8:43 AM

>Plagiocephalyegroups

>Subject: Re: Did Cigna HMO pay for your DOC band?

>

>

>Oh Gosh...all this cosmetic " surgery vs. therapy " pertaining to the

>AMA Resolution may be my fault. You see, when I composed my appeal

>letter, I quoted from the AMA Resolution but added the word THERAPY

>in parenthesis. I did submit the actual resolution, with my appeal,

>for their review (along with a ton of other information).

>Alhough " surgery " is the actual word used in the resolution,

>insurance companies are stating that banding therapy is cosmetic in

>nature. Since banding is a therapeutic treatment for this

>developmental deformity, and does not involve surgery (except when

>used after surgery in cases of craniosynostosis), I added the word

>therapy for emphasis. I am so sorry for this confusion! (But,

>hey...my appeal worked and for that I am ever so grateful!)

>

>Good luck to all of you!

>

>All my best,

>

>Polly and (DOC Band Graduate)

>

>

> > >

> > >

> > >

> > > [eGroups] My Groups | Plagiocephaly Main Page | Start a

> > > new group!

> > >

> > > :

> > >

> > > Go to the Files section, and look under insurance/appeals (I can't

> > > remember the name of the folder). CIGNA HMO did pay 100% for our

>DOC

> > > band after one denial, and the appeal letter that is posted in

>there

> > > (which was actually pieced together towards our case by bits and

> > > pieces of other letters - letters Cranial Tech gave us as well as

> > > posted here by other successful appeals....) Try to use their

> > > language/reason and refute it logically, and to use any and all

>causes

> > > towards the plagiocephaly (in utero constraint, vacuum extraction,

> > > toricollis, etc. with documentation from your pediatrician if

> > > possible), and what you've done so far to correct it without the

>band

> > > (for example, positioning, PT for torticollis, etc. again with

> > > documentation either in picture form or from your pediatrician

>(for

> > > example, the RX for physical Therapy for Tort...) etc.).

> > >

> > > Good luck!

> > > H.

> > > -----Original Message-----

> > > From: Agahi [mailto:.Agahi@u...]On Behalf Of

> > > Agahi

> > > Sent: Wednesday, September 20, 2000 9:57 AM

> > > Plagiocephalyegroups

> > > Subject: Did Cigna HMO pay for your DOC band?

> > >

> > > Well, We are still fighting with Cigna HMO to pay for my son's DOC

> > > band.

> > > We started very late. He was 22 months. I just need to know if

>Cigna

> > > HMO

> > > has paid for a DOC band this late or have they every paid for the

>DOC

> > > band or any information regarding this. I really appreciate you

> > > sharing

> > > this information in advance.

> > >

> > > Thanks,

> > > Arshi's mom,

> > >

> > >

[Guest guest]

Thanks ...(glad to know that what I did was " grammatically "

correct!)

I don't recall the 1997 Craniosynostosis and Skull Molding Symposium

Guidelines. Would you mind posting a copy in the files

under " Insurance Help " ? You're a peach!!!

Polly

> > >

> > >

> > >

> > > [eGroups] My Groups | Plagiocephaly Main Page | Start a

> > > new group!

> > >

> > > :

> > >

> > > Go to the Files section, and look under insurance/appeals (I

can't

> > > remember the name of the folder). CIGNA HMO did pay 100% for

our

> DOC

> > > band after one denial, and the appeal letter that is posted in

> there

> > > (which was actually pieced together towards our case by bits and

> > > pieces of other letters - letters Cranial Tech gave us as well

as

> > > posted here by other successful appeals....) Try to use their

> > > language/reason and refute it logically, and to use any and all

> causes

> > > towards the plagiocephaly (in utero constraint, vacuum

extraction,

> > > toricollis, etc. with documentation from your pediatrician if

> > > possible), and what you've done so far to correct it without the

> band

> > > (for example, positioning, PT for torticollis, etc. again with

> > > documentation either in picture form or from your pediatrician

> (for

> > > example, the RX for physical Therapy for Tort...) etc.).

> > >

> > > Good luck!

> > > H.

> > > -----Original Message-----

> > > From: Agahi [mailto:.Agahi@u...]On Behalf Of

> > > Agahi

> > > Sent: Wednesday, September 20, 2000 9:57 AM

> > > Plagiocephalyegroups

> > > Subject: Did Cigna HMO pay for your DOC band?

> > >

> > > Well, We are still fighting with Cigna HMO to pay for my son's

DOC

> > > band.

> > > We started very late. He was 22 months. I just need to know if

> Cigna

> > > HMO

> > > has paid for a DOC band this late or have they every paid for

the

> DOC

> > > band or any information regarding this. I really appreciate you

> > > sharing

> > > this information in advance.

> > >

> > > Thanks,

> > > Arshi's mom,

> > >

> > >

[Guest guest]

Hi LaurLee!

I would definately use your tapes if you feel it shows development of

plagio in utero. I simply forwarded the physician notes from my

obstetrician, which documented the monthly ultrasounds done to

monitor the " uterine band " during 's gestation. This, at the

very least, gave credance to the intrauterine constraint theory.

Also, was a premie, had a traumatic delivery and spent some time

in the NICU...all these are also correlating factors to plagio

development and, again, I submitted appropriate hospital records. If

I can be of any further help please let me know...Gotta go... has

a major stinky and my eyes are beginning to water!!!!

Best wishes,

Polly

> > > >

> > > >

> > > >

> > > > [eGroups] My Groups | Plagiocephaly Main Page | Start a

> > > > new group!

> > > >

> > > > :

> > > >

> > > > Go to the Files section, and look under insurance/appeals (I

can't

> > > > remember the name of the folder). CIGNA HMO did pay 100% for

our

> >DOC

> > > > band after one denial, and the appeal letter that is posted in

> >there

> > > > (which was actually pieced together towards our case by bits

and

> > > > pieces of other letters - letters Cranial Tech gave us as

well as

> > > > posted here by other successful appeals....) Try to use their

> > > > language/reason and refute it logically, and to use any and

all

> >causes

> > > > towards the plagiocephaly (in utero constraint, vacuum

extraction,

> > > > toricollis, etc. with documentation from your pediatrician if

> > > > possible), and what you've done so far to correct it without

the

> >band

> > > > (for example, positioning, PT for torticollis, etc. again with

> > > > documentation either in picture form or from your pediatrician

> >(for

> > > > example, the RX for physical Therapy for Tort...) etc.).

> > > >

> > > > Good luck!

> > > > H.

> > > > -----Original Message-----

> > > > From: Agahi [mailto:.Agahi@u...]On Behalf Of

> > > > Agahi

> > > > Sent: Wednesday, September 20, 2000 9:57 AM

> > > > Plagiocephalyegroups

> > > > Subject: Did Cigna HMO pay for your DOC band?

> > > >

> > > > Well, We are still fighting with Cigna HMO to pay for my

son's DOC

> > > > band.

> > > > We started very late. He was 22 months. I just need to know if

> >Cigna

> > > > HMO

> > > > has paid for a DOC band this late or have they every paid for

the

> >DOC

> > > > band or any information regarding this. I really appreciate

you

> > > > sharing

> > > > this information in advance.

> > > >

> > > > Thanks,

> > > > Arshi's mom,

> > > >

> > > >

[Guest guest]

The AMA Resolution (119) is posted in the Files section

under " Insurance Help " . Hopefully, will share the Cranio

Symposium Guidelines with us as I am not familiar with those. Good

luck on your insurance fight!

All my best,

Polly

> > > >

> > > >

> > > >

> > > > [eGroups] My Groups | Plagiocephaly Main Page | Start a

> > > > new group!

> > > >

> > > > :

> > > >

> > > > Go to the Files section, and look under insurance/appeals (I

can't

> > > > remember the name of the folder). CIGNA HMO did pay 100% for

our

> >DOC

> > > > band after one denial, and the appeal letter that is posted in

> >there

> > > > (which was actually pieced together towards our case by bits

and

> > > > pieces of other letters - letters Cranial Tech gave us as

well as

> > > > posted here by other successful appeals....) Try to use their

> > > > language/reason and refute it logically, and to use any and

all

> >causes

> > > > towards the plagiocephaly (in utero constraint, vacuum

extraction,

> > > > toricollis, etc. with documentation from your pediatrician if

> > > > possible), and what you've done so far to correct it without

the

> >band

> > > > (for example, positioning, PT for torticollis, etc. again with

> > > > documentation either in picture form or from your pediatrician

> >(for

> > > > example, the RX for physical Therapy for Tort...) etc.).

> > > >

> > > > Good luck!

> > > > H.

> > > > -----Original Message-----

> > > > From: Agahi [mailto:.Agahi@u...]On Behalf Of

> > > > Agahi

> > > > Sent: Wednesday, September 20, 2000 9:57 AM

> > > > Plagiocephalyegroups

> > > > Subject: Did Cigna HMO pay for your DOC band?

> > > >

> > > > Well, We are still fighting with Cigna HMO to pay for my

son's DOC

> > > > band.

> > > > We started very late. He was 22 months. I just need to know if

> >Cigna

> > > > HMO

> > > > has paid for a DOC band this late or have they every paid for

the

> >DOC

> > > > band or any information regarding this. I really appreciate

you

> > > > sharing

> > > > this information in advance.

> > > >

> > > > Thanks,

> > > > Arshi's mom,

> > > >

> > > >

[Guest guest]

Dear Polly,

That was an unbelievable appeal letter! Thank you so much for

posting it--it will be of immense value. One question...did you

include copies of the texts of your endnotes/references along with

your appeal? My appeal is looking like a term paper, but I'm afraid

they may not read/research the references if I don't include them!

Thanks again very much, Sue

> > > > >

> > > > >

> > > > >

> > > > > [eGroups] My Groups | Plagiocephaly Main Page | Start a

> > > > > new group!

> > > > >

> > > > > :

> > > > >

> > > > > Go to the Files section, and look under insurance/appeals

(I

> can't

> > > > > remember the name of the folder). CIGNA HMO did pay 100%

for

> our

> > >DOC

> > > > > band after one denial, and the appeal letter that is posted

in

> > >there

> > > > > (which was actually pieced together towards our case by

bits

> and

> > > > > pieces of other letters - letters Cranial Tech gave us as

> well as

> > > > > posted here by other successful appeals....) Try to use

their

> > > > > language/reason and refute it logically, and to use any and

> all

> > >causes

> > > > > towards the plagiocephaly (in utero constraint, vacuum

> extraction,

> > > > > toricollis, etc. with documentation from your pediatrician

if

> > > > > possible), and what you've done so far to correct it

without

> the

> > >band

> > > > > (for example, positioning, PT for torticollis, etc. again

with

> > > > > documentation either in picture form or from your

pediatrician

> > >(for

> > > > > example, the RX for physical Therapy for Tort...) etc.).

> > > > >

> > > > > Good luck!

> > > > > H.

> > > > > -----Original Message-----

> > > > > From: Agahi [mailto:.Agahi@u...]On Behalf Of

> > > > > Agahi

> > > > > Sent: Wednesday, September 20, 2000 9:57 AM

> > > > > Plagiocephalyegroups

> > > > > Subject: Did Cigna HMO pay for your DOC band?

> > > > >

> > > > > Well, We are still fighting with Cigna HMO to pay for my

> son's DOC

> > > > > band.

> > > > > We started very late. He was 22 months. I just need to know

if

> > >Cigna

> > > > > HMO

> > > > > has paid for a DOC band this late or have they every paid

for

> the

> > >DOC

> > > > > band or any information regarding this. I really appreciate

> you

> > > > > sharing

> > > > > this information in advance.

> > > > >

> > > > > Thanks,

> > > > > Arshi's mom,

> > > > >

> > > > >

[Guest guest]

> Dear Polly,

> That was an unbelievable appeal letter! Thank you so much for

> posting it--it will be of immense value. One question...did you

> include copies of the texts of your endnotes/references along with

> your appeal? My appeal is looking like a term paper, but I'm

afraid

> they may not read/research the references if I don't include them!

> Thanks again very much, Sue

Hi Sue...I felt the very same way about my appeal letter...all the

research, referencing, etc...I even sent it in a notebook binder,

along with photos detailing the severity of 's plagio. Yes, I

included a hard copy of ALL referenced material, including physician

progress notes. I sent it via certified mail. Believe it or not,

approval came the same day they recieved the package! Satisfaction

for me is that this letter has been a " springboard " for other parents

in their appeal battles. I wish you much success!!!

Polly

[Guest guest]

Polly, Thanks for your reply. I will do the same and also send via

certified mail. I hope we're as sucessful as you were! Sue

> > Dear Polly,

> > That was an unbelievable appeal letter! Thank you so much for

> > posting it--it will be of immense value. One question...did you

> > include copies of the texts of your endnotes/references along

with

> > your appeal? My appeal is looking like a term paper, but I'm

> afraid

> > they may not read/research the references if I don't include

them!

> > Thanks again very much, Sue

>

>

> Hi Sue...I felt the very same way about my appeal letter...all the

> research, referencing, etc...I even sent it in a notebook binder,

> along with photos detailing the severity of 's plagio. Yes, I

> included a hard copy of ALL referenced material, including

physician

> progress notes. I sent it via certified mail. Believe it or not,

> approval came the same day they recieved the package! Satisfaction

> for me is that this letter has been a " springboard " for other

parents

> in their appeal battles. I wish you much success!!!

>

> Polly