Re: NEW HERE- INSURANCE QUESTION...

[Guest guest]

Welcome to the group! If you check out the files section to your

left there is an insurance help folder. I believe that there are a

few successful appeal letters for not a covered benefit. Which

insurance do you have? There are numerous things on the internet

that can help. I am currently appealing my insurance denial for not

a medical necessity, and hidden from members an exclusion that states

cranial orthosis is only covered after surgery. Let me know what I

can do to help, as all of my research is readily available.

I am also the mother of twin girls Raegan required a band, Kaelyn is

perfectly rounded.

mother Bryce 3, Kaelyn 5mos, Raegan 5mos (DOC Band 12/22/03)

Overland Park, KS

--- In Plagiocephaly , " renee_oriarte " <RORIARTE@H...>

wrote:

> HI EVERYONE! MY 4 MO DAUGHTER HAS RECENTLY BEEN DIAGNOSED WITH

> SEVERE PLAGIO. SHE IS 11CM OFF, SHE IS A TWIN, AND HER SISTER IS

> ONLY 3CM OFF. I USUALLY HANDLE SITUATIONS VERY WELL, BUT THIS HAS

ME

> A NERVOUS WRECK. I'M AWAITING MY DENIAL LETTER, IT WAS MAILED

1/9.

> I THINK THE REASON FOR DENIAL IS " NOT A COVERED BENIFIT " . HAVE ANY

> OF YOU HEARD OF ANYONE APPEALING THIS ONE, AND IS IT EVEN WORTH

IT?

> I THINK I WOULD LOSE.

[Guest guest]

Hi and welcome to the group. Who is your insurance company? Maybe

someone has them and was successful in getting them to pay. Do you

have an HMO or PPO or something else? I wish you luck and hope we

can help you with this fight.

Dustie, Mom to , DOCGrad'03

Texas

--- In Plagiocephaly , " renee_oriarte " <RORIARTE@H...>

wrote:

> HI EVERYONE! MY 4 MO DAUGHTER HAS RECENTLY BEEN DIAGNOSED WITH

> SEVERE PLAGIO. SHE IS 11CM OFF, SHE IS A TWIN, AND HER SISTER IS

> ONLY 3CM OFF. I USUALLY HANDLE SITUATIONS VERY WELL, BUT THIS HAS

ME

> A NERVOUS WRECK. I'M AWAITING MY DENIAL LETTER, IT WAS MAILED

1/9.

> I THINK THE REASON FOR DENIAL IS " NOT A COVERED BENIFIT " . HAVE ANY

> OF YOU HEARD OF ANYONE APPEALING THIS ONE, AND IS IT EVEN WORTH

IT?

> I THINK I WOULD LOSE.

[Guest guest]

Hi and welcome to the group. What type of ins do you have? There

is a good chance someone here might have some experience with the

same type. We were denied for both bands we had and in the end got

both covered 100%. I'd say any denial reason is worth the fight

unless money isn't an issue for you. It's alot of frustrating work

for these appeals often, but it really pays off for many people.

Where is your daugher getting treatment? She's really young and

should see great correction. My daughter's plagio was severe at

20mm and was banded at 4.5 mos. You can see her progress photos in

the " Hannah " folders.

, mom to Hannah, DOCgrad

Cape Cod, Ma

> HI EVERYONE! MY 4 MO DAUGHTER HAS RECENTLY BEEN DIAGNOSED WITH

> SEVERE PLAGIO. SHE IS 11CM OFF, SHE IS A TWIN, AND HER SISTER IS

> ONLY 3CM OFF. I USUALLY HANDLE SITUATIONS VERY WELL, BUT THIS HAS

ME

> A NERVOUS WRECK. I'M AWAITING MY DENIAL LETTER, IT WAS MAILED

1/9.

> I THINK THE REASON FOR DENIAL IS " NOT A COVERED BENIFIT " . HAVE

ANY

> OF YOU HEARD OF ANYONE APPEALING THIS ONE, AND IS IT EVEN WORTH

IT?

> I THINK I WOULD LOSE.

[Guest guest]

THANK YOU TO EVERYONE WHO REPLIED TO MY POST. I FORGOT TO MENTION MY

INS IS PACIFICARE OF ARIZONA (WERE IN TUCSON - 78 DEGREES:) I WILL

CHECK OUT ALL OF YOUR SUGGESTIONS, I REALLY APPRECIATE THE ADVICE! I

NEED TO APPEAL, I'M STILL PAYING ON MY CO-PAYS FROM THEIR BIRTH.

THIS INSURANCE APPEAL PROCESS IS OVERWHELMING. BUT I'M TOUGH, I JUST

NEED CONFIDENCE. I ALSO JUST FOUND OUT THAT STATE AID COVERS THE

BANDS/HELMETS! WE PAY INSURANCE PREMIUMS EVERY PAYCHECK AND THEY

DON'T COVER ANYTHING. IT'S FUSTRATING. I'LL KEEP IN TOUCH, - I

STILL HAVEN'T RECEIVED THE LETTER! I THINK I'M JUST GOING TO START

ON THE APPEAL.

> > HI EVERYONE! MY 4 MO DAUGHTER HAS RECENTLY BEEN DIAGNOSED WITH

> > SEVERE PLAGIO. SHE IS 11CM OFF, SHE IS A TWIN, AND HER SISTER IS

> > ONLY 3CM OFF. I USUALLY HANDLE SITUATIONS VERY WELL, BUT THIS

HAS

> ME

> > A NERVOUS WRECK. I'M AWAITING MY DENIAL LETTER, IT WAS MAILED

> 1/9.

> > I THINK THE REASON FOR DENIAL IS " NOT A COVERED BENIFIT " . HAVE

ANY

> > OF YOU HEARD OF ANYONE APPEALING THIS ONE, AND IS IT EVEN WORTH

> IT?

> > I THINK I WOULD LOSE.