Re: BCBS of NC appeal hearing, etc.

[Guest guest]

In a message dated 11/4/2002 2:42:36 PM Eastern Standard Time, amy_coppedge@... writes:

emma has

been receiving regular craniosacral treatment. and i just took her to

see the french osteopath Jean-Pierre Barral. her visit with him was

simply amazing. i actually saw the plates (i'm not sure what you

call them...)in her head move in his hands! and i saw immediate

improvement in her head shape and ear alignment. i encourage others to

seek treatment from an osteopath and/or craniosacral therapist.

Amy,

So nice to hear the great news on Emma! Sorry I can't help out with any appeals info, but you know this Board, plenty of members willing to help out so I'm sure you'll get a ton of great advice. I couldn't agree with you more on recommending craniosacral therapy- we used a few techniques that our pt showed us, mostly only for relaxation for the tort, but one was a direction of energy exercise and it was used to help dissipate his hematoma- we feel it really helped too, it seemed to get smaller once we started using this. Very interesting about the plates shifting! I thought it was very hokey starting out, but gave it a chance and I'm so glad we did- I have only heard others speak highly of this as well, a great complimentary therapy for sure!

Keep up the great work and please keep us updated on how the CS therapy is working as well!

' mom

[Guest guest]

Amy,

Do you get to go in person to the hearing? On our level 2 appeal with Cigna we had the choice of going in person or doing a conference call. I wanted to go, but my hubby didn't want to miss that much work, and then my whole family got the stomach flu, and at the last minute we had to go with the conference call. This in the only thing in my entire appeals process that I would have done differently. I really think that they were not paying attention to anything we said. We could hear papers shuffling in the background, but they never responded to anything we said in the entire call. At the end, the coordinator said something, and I swear she woke them all up. If we had been there in person, I would have been able to look them in the eye and make sure they heard and understood what I was saying. When we got our denial letter a week later, it was VERY clear that they had not listened during the call. So my advice it to get their full attention, and show them just how much homework you have done and that you are well educated on plagiocephaly and cranial molding devices. Wow them with your expertise!!! You'll do great. Send me an email if you want more details about how our meeting went.

Gail, Sam and Sara's mom, DOC grads

BCBS of NC appeal hearing, etc.

hi everyone! we have our appeal hearing this thursday and i'd love some advice from those of you who have gone through such a process. i'm really nervous about it and don't know what to expect.also, i'd like to take a second to thank all of you for all the great advice i've received for all these months. even though i don't have time to read many posts or respond, just knowing there are others who understand what i'm going through is a huge comfort. i thank the group of you every days for encouraging me to follow my gut and not the advice of doctors in pursuing treatment for emma's severe plagio. she's been in her second DOC band for about 2 months now - at age 13 months - and we continue to see improvement.i'd also like to mention that in addition to the DOC band, emma has been receiving regular craniosacral treatment. and i just took her to see the french osteopath Jean-Pierre Barral. her visit with him was simply amazing. i actually saw the plates (i'm not sure what you call them...)in her head move in his hands! and i saw immediate improvement in her head shape and ear alignment. i encourage others to seek treatment from an osteopath and/or craniosacral therapist.so, if anyone has any advice on the appeal hearing, i'd love to hear from you.thanks for everything!amymom to emma (born 9/24/01)For more plagio info

[Guest guest]

Hi Amy - we went through an in-person appeal hearing. I'm sure they all differ,

but basically I was in a conference room with a group of people selected to be

on their appeal board. Some were doctors and some were not. They asked questions

and gave me a chance to bascially " plead my case " . Sadly I was still denied even

after this process. Hopefully it will work out better for you. I'm sure you will

do great.

Marci (Mom to )

Oklahoma

[Guest guest]

gail,

i am planning on going to the hearing. apparently the " panel " consists

of two doctors who will be hooked in by phone. their identities are to

remain confidential. i'm curious as to what types of questions you

asked and were asked. our denial at first was that DOC banding was not

medically necessary, but the latest letter states that the denial is

because DOC banding is cosmetic. i'm nervous about the whole thing.

although i submitted lots of information, i'm afraid they're going to

try and " trick " me somehow. know what i mean?

amy

> Amy,

> Do you get to go in person to the hearing? On our level 2 appeal

with Cigna we had the choice of going in person or doing a conference

call. I wanted to go, but my hubby didn't want to miss that much

work, and then my whole family got the stomach flu, and at the last

minute we had to go with the conference call. This in the only thing

in my entire appeals process that I would have done differently. I

really think that they were not paying attention to anything we said.

We could hear papers shuffling in the background, but they never

responded to anything we said in the entire call. At the end, the

coordinator said something, and I swear she woke them all up. If we

had been there in person, I would have been able to look them in the

eye and make sure they heard and understood what I was saying. When

we got our denial letter a week later, it was VERY clear that they had

not listened during the call. So my advice it to get their full

attention, and show them just how much homework you have done and that

you are well educated on plagiocephaly and cranial molding devices.

Wow them with your expertise!!! You'll do great. Send me an email if

you want more details about how our meeting went.

>

> Gail, Sam and Sara's mom, DOC grads

> BCBS of NC appeal hearing, etc.

>

>

> hi everyone! we have our appeal hearing this thursday and i'd love

> some advice from those of you who have gone through such a

process.

> i'm really nervous about it and don't know what to expect.

>

> also, i'd like to take a second to thank all of you for all the

great

> advice i've received for all these months. even though i don't

have

> time to read many posts or respond, just knowing there are others

who

> understand what i'm going through is a huge comfort. i thank the

group

> of you every days for encouraging me to follow my gut and not the

> advice of doctors in pursuing treatment for emma's severe plagio.

> she's been in her second DOC band for about 2 months now - at age

13

> months - and we continue to see improvement.

>

> i'd also like to mention that in addition to the DOC band, emma

has

> been receiving regular craniosacral treatment. and i just took her

to

> see the french osteopath Jean-Pierre Barral. her visit with him

was

> simply amazing. i actually saw the plates (i'm not sure what you

> call them...)in her head move in his hands! and i saw immediate

> improvement in her head shape and ear alignment. i encourage

others to

> seek treatment from an osteopath and/or craniosacral therapist.

>

> so, if anyone has any advice on the appeal hearing, i'd love to

hear

> from you.

>

> thanks for everything!

> amy

> mom to emma (born 9/24/01)

>

>

> For more plagio info

[Guest guest]

Amy,

That's great that you are going, but I would be leary of the doctors on the phone. Try to be clever and make sure you have their attention. Maybe ask them if they are familiar with a particular term or something like that. The sad thing about our appeal was that they didn't ask ANY questions, and they cut us off so quick that we didn't really ask any either. They basically got us on the phone and told us to begin. We had no idea if they even knew what a helmet was or if they had read any of our letters, so we basically just told our story, beginning with what we thought caused the plagio and tort. We told them their birth weight and what all my sonograms showed, and that was basically that they were very cramped in utero and were never able to roll over after about week 20, so they were born with the problem. Then we talked about the back to sleep campaign and how it contributed and made things worse. Then my husband addressed the specific denial reasons and presented all the documentation to support our arguments. I really don't know what we could have done differently. I really think that they had made up their mind prior to our phone call. I really hope that you have a better audience and get better results than we did. Please let me know how it goes.

Gail

BCBS of NC appeal hearing, etc.> > > hi everyone! we have our appeal hearing this thursday and i'd love > some advice from those of you who have gone through such a process. > i'm really nervous about it and don't know what to expect.> > also, i'd like to take a second to thank all of you for all the great > advice i've received for all these months. even though i don't have > time to read many posts or respond, just knowing there are others who > understand what i'm going through is a huge comfort. i thank the group > of you every days for encouraging me to follow my gut and not the > advice of doctors in pursuing treatment for emma's severe plagio. > she's been in her second DOC band for about 2 months now - at age 13 > months - and we continue to see improvement.> > i'd also like to mention that in addition to the DOC band, emma has > been receiving regular craniosacral treatment. and i just took her to > see the french osteopath Jean-Pierre Barral. her visit with him was > simply amazing. i actually saw the plates (i'm not sure what you > call them...)in her head move in his hands! and i saw immediate > improvement in her head shape and ear alignment. i encourage others to > seek treatment from an osteopath and/or craniosacral therapist.> > so, if anyone has any advice on the appeal hearing, i'd love to hear > from you.> > thanks for everything!> amy> mom to emma (born 9/24/01)> > > For more plagio info