RE: Re: Torticollis - Horizon BCBS NJ/ Ins help

[Guest guest]

Hi Ken,

Welcome to the group. I had to appeal because of a contract exclusion. I covered a little of everything in my appeal. There's a copy of it in the insurance section in the contract exclusion folder. It has references cited on the web with links. In addition to the research I provided chronological pics that we had taken and pointed out the problems (you could include photos of your son's tilt due to tort if it's noticeable). na developed her torticollis (mild, had to spot the tilt) and plagio inutero (there's an article about the tie in between the two). I sent them my 7 page letter and about 50 pages of research. I won the appeal. My company is self insured. It turns out Companion was working from the wrong contract - morons!! It should have been covered all along.

I would define cosmetic, abnormal, plagio (use strong words like twisted skull base - obviously not cosmetic), and torticollis in your appeal. Cite the AMA resolution, AAP treatment guidelines (draft from Nov mtg), state of CT law, Senate and HR proposed legislation (see links page in our group). Go from the point of view that because of a functional problem (tort) he developed an abnormality. Get letters of medical necessity from your ped and neurosurgeon (or other specialist if you are using one). Your ortho at CT is not allowed to offer a diagnosis legally, but you can paraphrase your discussions. I did some of this in my appeal.

Let me know if I can help anymore.

mom to na

DOC #1 10-27 to 11-26

DOC #2 12-10 to (~3 weeks to go)

Re: Torticollis - Horizon BCBS NJ/ Ins help

Hi & welcome to our group:I checked our insurance DATABASE & typed in Horizon in the search box, unfortunately, no matches were found. We do have MANY members who have or still are battled insurance for coverage. Many have been denied on the "cosmetic" reasons as well.Check out both our FILES & LINKS "Insurance Help" sections in our group. There's a ton of helpful articles, appeal letters and much much more that will hopefully be of help to you.I've also added "Horizon BCBS NJ/Ins help" to your subject line to grab more members attn to your post. Hopefully someone will help you there.How is he doing in the DOCband? How's his tort progressing?Debbie Abby's mom DOCGradMI> Hello,> > I am new to this website. My wife and I are seeking some advice or > assistance.> > My son has recently been fitted for a Doc Band due to the shape of > his head. It is believed to be caused by torticollis. We have > submitted our bills to the insurance company and have been denied > twice. Our insurance company is Horizon Blue Cros Blue Shield of New > Jersey. Is there anyone who has a child with torticollis, was fitted > for a Doc Band, and got this covered through Horizon? If so, would > you be willing to share your information with us? I would be happy > to share with you my other email address and discuss the situation > further privately. As you may know, the cost for the Doc Band is > $3,000. Any information would be helpful. I cannot believe the > Insurance Co. is telling me it is "cosmetic". I would love the > insurance company to come to my house, as we do stretches and > excercises that can take up to 30 minutes three times a day to > strengthen his neck, and tell me it is "cosmetic".For more plagio info

[Guest guest]

Thank you so much. He is doing well, but the torticollis is taking some time. We continue to do physical therapy and stretching 3 times a day and see a therapist once a week.

I really appreciate you taking the time to respond. I know I will win this appeal, I just need to put the time in to get to know everything.

Thanks again!!!!!

Ken for NJ

Re: Torticollis - Horizon BCBS NJ/ Ins help

Hi & welcome to our group:I checked our insurance DATABASE & typed in Horizon in the search box, unfortunately, no matches were found. We do have MANY members who have or still are battled insurance for coverage. Many have been denied on the "cosmetic" reasons as well.Check out both our FILES & LINKS "Insurance Help" sections in our group. There's a ton of helpful articles, appeal letters and much much more that will hopefully be of help to you.I've also added "Horizon BCBS NJ/Ins help" to your subject line to grab more members attn to your post. Hopefully someone will help you there.How is he doing in the DOCband? How's his tort progressing?Debbie Abby's mom DOCGradMI> Hello,> > I am new to this website. My wife and I are seeking some advice or > assistance.> > My son has recently been fitted for a Doc Band due to the shape of > his head. It is believed to be caused by torticollis. We have > submitted our bills to the insurance company and have been denied > twice. Our insurance company is Horizon Blue Cros Blue Shield of New > Jersey. Is there anyone who has a child with torticollis, was fitted > for a Doc Band, and got this covered through Horizon? If so, would > you be willing to share your information with us? I would be happy > to share with you my other email address and discuss the situation > further privately. As you may know, the cost for the Doc Band is > $3,000. Any information would be helpful. I cannot believe the > Insurance Co. is telling me it is "cosmetic". I would love the > insurance company to come to my house, as we do stretches and > excercises that can take up to 30 minutes three times a day to > strengthen his neck, and tell me it is "cosmetic".For more plagio info

[Guest guest]

Hi,

I've been a member of this group for a few months, but this is my first time posting (because I'm at work).

I would be glad to help with Horizon BCBS NJ.

My eight-month-old son, , wears a DOC Band, and, initially, Horizon refused to pay. However, using the information I found in this group, I successfully appealed. In fact, they approved it due to his torticollis. Their exact words were, "Given the presence of the torticollis and the recommendation from independent review, the DOC Band is approved for this patient."

Ken, I will e-mail you a copy of my appeal letter and, some time this week, add it to the Insurance database.

Dennis

From: Ken and Bull [mailto:klmbbulldog@...] Sent: Tuesday, February 10, 2004 7:54 PMPlagiocephaly Subject: Re: Re: Torticollis - Horizon BCBS NJ/ Ins help

Thank you so much. He is doing well, but the torticollis is taking some time. We continue to do physical therapy and stretching 3 times a day and see a therapist once a week.

I really appreciate you taking the time to respond. I know I will win this appeal, I just need to put the time in to get to know everything.

Thanks again!!!!!

Ken for NJ

Re: Torticollis - Horizon BCBS NJ/ Ins help

Hi & welcome to our group:I checked our insurance DATABASE & typed in Horizon in the search box, unfortunately, no matches were found. We do have MANY members who have or still are battled insurance for coverage. Many have been denied on the "cosmetic" reasons as well.Check out both our FILES & LINKS "Insurance Help" sections in our group. There's a ton of helpful articles, appeal letters and much much more that will hopefully be of help to you.I've also added "Horizon BCBS NJ/Ins help" to your subject line to grab more members attn to your post. Hopefully someone will help you there.How is he doing in the DOCband? How's his tort progressing?Debbie Abby's mom DOCGradMI> Hello,> > I am new to this website. My wife and I are seeking some advice or > assistance.> > My son has recently been fitted for a Doc Band due to the shape of > his head. It is believed to be caused by torticollis. We have > submitted our bills to the insurance company and have been denied > twice. Our insurance company is Horizon Blue Cros Blue Shield of New > Jersey. Is there anyone who has a child with torticollis, was fitted > for a Doc Band, and got this covered through Horizon? If so, would > you be willing to share your information with us? I would be happy > to share with you my other email address and discuss the situation > further privately. As you may know, the cost for the Doc Band is > $3,000. Any information would be helpful. I cannot believe the > Insurance Co. is telling me it is "cosmetic". I would love the > insurance company to come to my house, as we do stretches and > excercises that can take up to 30 minutes three times a day to > strengthen his neck, and tell me it is "cosmetic".For more plagio info

[Guest guest]

thanks. That will help out many. I'm glad you received coverage for s band. How is he doing?

Angie and Jenna(STARgrad)

Re: Torticollis - Horizon BCBS NJ/ Ins help

Hi & welcome to our group:I checked our insurance DATABASE & typed in Horizon in the search box, unfortunately, no matches were found. We do have MANY members who have or still are battled insurance for coverage. Many have been denied on the "cosmetic" reasons as well.Check out both our FILES & LINKS "Insurance Help" sections in our group. There's a ton of helpful articles, appeal letters and much much more that will hopefully be of help to you.I've also added "Horizon BCBS NJ/Ins help" to your subject line to grab more members attn to your post. Hopefully someone will help you there.How is he doing in the DOCband? How's his tort progressing?Debbie Abby's mom DOCGradMI> Hello,> > I am new to this website. My wife and I are seeking some advice or > assistance.> > My son has recently been fitted for a Doc Band due to the shape of > his head. It is believed to be caused by torticollis. We have > submitted our bills to the insurance company and have been denied > twice. Our insurance company is Horizon Blue Cros Blue Shield of New > Jersey. Is there anyone who has a child with torticollis, was fitted > for a Doc Band, and got this covered through Horizon? If so, would > you be willing to share your information with us? I would be happy > to share with you my other email address and discuss the situation > further privately. As you may know, the cost for the Doc Band is > $3,000. Any information would be helpful. I cannot believe the > Insurance Co. is telling me it is "cosmetic". I would love the > insurance company to come to my house, as we do stretches and > excercises that can take up to 30 minutes three times a day to > strengthen his neck, and tell me it is "cosmetic".For more plagio info

[Guest guest]

is doing great. Thanks.

He's been in the band full time for about two months and does not mind it. His ears are still not aligned, though, so he probably has a few more months.

Dennis

From: Angie Pope [mailto:apope@...] Sent: Wednesday, February 11, 2004 1:14 PMPlagiocephaly Subject: Re: Re: Torticollis - Horizon BCBS NJ/ Ins help

thanks. That will help out many. I'm glad you received coverage for s band. How is he doing?

Angie and Jenna(STARgrad)

Re: Torticollis - Horizon BCBS NJ/ Ins help

Hi & welcome to our group:I checked our insurance DATABASE & typed in Horizon in the search box, unfortunately, no matches were found. We do have MANY members who have or still are battled insurance for coverage. Many have been denied on the "cosmetic" reasons as well.Check out both our FILES & LINKS "Insurance Help" sections in our group. There's a ton of helpful articles, appeal letters and much much more that will hopefully be of help to you.I've also added "Horizon BCBS NJ/Ins help" to your subject line to grab more members attn to your post. Hopefully someone will help you there.How is he doing in the DOCband? How's his tort progressing?Debbie Abby's mom DOCGradMI> Hello,> > I am new to this website. My wife and I are seeking some advice or > assistance.> > My son has recently been fitted for a Doc Band due to the shape of > his head. It is believed to be caused by torticollis. We have > submitted our bills to the insurance company and have been denied > twice. Our insurance company is Horizon Blue Cros Blue Shield of New > Jersey. Is there anyone who has a child with torticollis, was fitted > for a Doc Band, and got this covered through Horizon? If so, would > you be willing to share your information with us? I would be happy > to share with you my other email address and discuss the situation > further privately. As you may know, the cost for the Doc Band is > $3,000. Any information would be helpful. I cannot believe the > Insurance Co. is telling me it is "cosmetic". I would love the > insurance company to come to my house, as we do stretches and > excercises that can take up to 30 minutes three times a day to > strengthen his neck, and tell me it is "cosmetic".For more plagio info

[Guest guest]

I am glad is doing so well. Thanks again for the insurance help.

Angie and jenna

Re: Torticollis - Horizon BCBS NJ/ Ins help

Hi & welcome to our group:I checked our insurance DATABASE & typed in Horizon in the search box, unfortunately, no matches were found. We do have MANY members who have or still are battled insurance for coverage. Many have been denied on the "cosmetic" reasons as well.Check out both our FILES & LINKS "Insurance Help" sections in our group. There's a ton of helpful articles, appeal letters and much much more that will hopefully be of help to you.I've also added "Horizon BCBS NJ/Ins help" to your subject line to grab more members attn to your post. Hopefully someone will help you there.How is he doing in the DOCband? How's his tort progressing?Debbie Abby's mom DOCGradMI> Hello,> > I am new to this website. My wife and I are seeking some advice or > assistance.> > My son has recently been fitted for a Doc Band due to the shape of > his head. It is believed to be caused by torticollis. We have > submitted our bills to the insurance company and have been denied > twice. Our insurance company is Horizon Blue Cros Blue Shield of New > Jersey. Is there anyone who has a child with torticollis, was fitted > for a Doc Band, and got this covered through Horizon? If so, would > you be willing to share your information with us? I would be happy > to share with you my other email address and discuss the situation > further privately. As you may know, the cost for the Doc Band is > $3,000. Any information would be helpful. I cannot believe the > Insurance Co. is telling me it is "cosmetic". I would love the > insurance company to come to my house, as we do stretches and > excercises that can take up to 30 minutes three times a day to > strengthen his neck, and tell me it is "cosmetic".For more plagio info