Denied!

[Guest guest]

Hi All,

Well I received word today that we were denied because there is an exclusion in the contract around cranial remolding. My company (DuPont) is self insured and has Companion Healthcare of SC manage their health insurance in SC. My site benefit advocate says I can appeal to DuPont. Anyone else work for DuPont (it's a big company)?

I have to state why I think the claim should be reconsidered. I'm going to go with the medical necessity obvious reasons and also the max out of pocket for individual ($1600) and family ($3000?). Since na is only 3 1/2 months old obvisouly we have paid all of the maternity medical expenses this year and are close to some of these amounts.

My in-laws have told us they will give us the $3000. My father in law and husband are in business for themselves (contracting). They have a large invoice coming due. It is mostly profit so my father-in-law said we could take it all. Yes, they are absolutely wonderful people. So, I'm not worried about the money, but it is the principle of the whole thing and that money can go in her college fund.

Has anyone appealed an exclusion and won? I think I may post my draft letter for you to critique sometime this weekend. I'm going to go look at all of the insurance links after I send this.

I went ahead and made all of na's appointments. She will be cast on 10/13 and pick up the band on 10/27 (my b-day). We would have done it today. I offered to leave work and be there in 3 hours, but that put the band in when all of the orthos are in AZ for training. Then we had to take into consideration we will be on vacation 10/18-10/26 (so no picking up the band early). So, the day after we get back we go to Charlotte. My husband won't be back from a seminar (he's leaving our vacation early) yet so my mother in law will be going with me on the 27th.

Off to battle the beaurocracy.

mom to na