Guest guest Posted March 16, 2004 Report Share Posted March 16, 2004 Hi Jen, Our insurance origionally covered the DOC Band at 50% out-o- network. We appealed and won the 80% in-network coverage. Our main points were that the band was medically neccessary and that our insurance company could not provide us with someone in-network. Our policy stated that we had the " option " of going in or out of network, but in our case we didn't have an option. I hope this was helpful. mom to Jake 20mo(DOC Band grad 2003) and Tyler 4yrs --- In Plagiocephaly , " jendoug796 " <jenballard@c...> wrote: > I will be taking my son (4 months) to a Cranial Technologies > facility next week for casting in CT. Found out that my insurance > co., Healthnet will only cover $1,050 (their maximum allowance), as > Cranial Tech is not in their network. > > Does anyone have experience in appealing the remaining cost which > will be $2k. > > > Thanks, > Jen Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 22, 2004 Report Share Posted July 22, 2004 My husband and I are struggling with our insurance company... surprise! We have already sent in one appeal letter which to honest looked like a college term paper it had so much information. Our appeal was of course denied. Has anyone had any success with winning an appeal with Fortis? They insist that the DOC band is cosmetic not reconstructive! I would love any advice I can get! Thanks - Gail Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 22, 2004 Report Share Posted July 22, 2004 Gail Lemme at 'em. Grrrrrrrrrrr! That is such a crock. I too had to appeal the " cosmetic " issue. Do you have to have an internal appeal where you meet with them? What is the next step? I'll bet your letter was great. I'm sure you mentioned all of the possible health effects of untreated plagio in your letter. I'm sorry; I don't have experience with that co. specifically but I imagine it's similar to others. Have you read all the help available here and on the cappskids.org website? GOOD LUCK and let me know. Sue Colin F. 10 mos., brachy STARband 6/29 Buffalo, NY > My husband and I are struggling with our insurance company... > surprise! We have already sent in one appeal letter which to honest > looked like a college term paper it had so much information. Our > appeal was of course denied. Has anyone had any success with > winning an appeal with Fortis? They insist that the DOC band is > cosmetic not reconstructive! I would love any advice I can get! > > Thanks - Gail Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 23, 2004 Report Share Posted July 23, 2004 Hi Gail, I never had to do an offical appeal, so I'm not too much help, but did you get the appeal packet from CT? I know they have it broken down by reason for denial and that many members have found it very helpful. , mom to Hannah, DOCband #3 3/30 Cape Cod, Ma > My husband and I are struggling with our insurance company... > surprise! We have already sent in one appeal letter which to honest > looked like a college term paper it had so much information. Our > appeal was of course denied. Has anyone had any success with > winning an appeal with Fortis? They insist that the DOC band is > cosmetic not reconstructive! I would love any advice I can get! > > Thanks - Gail Quote Link to comment Share on other sites More sharing options...
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