Re: Take a stand for the children

[Guest guest]

Good luck Avigale's mom.

I will do it!!!

....because I have to go in front of a however-many-member committee

of physicians on July 15th and that is just unreal! Do you think I

should report them before or after the appeal meeting? I don't want

to lessen my chances in any way...I'll have to think about this...

Sue (mom to Colin F., 9 mos, brachy, rt plag, STARband 6/29/04)

Buffalo, NY

> Hello everyone,

>

> I want to encourage ALL of you to take a stand against the

insurance

> companies. Being a mom myself, I know how much time it takes to be

a

> mommy. However, we need to band together to try to make getting

> these bands easier. If your insurance company made you appeal for

> coverage or flat out denied you, please contact your state

insurance

> company ASAP. You can find the address and information via the

> internet, very easily. Some complaints can be filed over the

> internet. My insurance company denied our first claim so we went

> through the appeals process to finally get it covered. It was

> extremely stressful. Parents should not have to fight insurance

(who

> they pay) to get their children a band. I wish I have more time to

> take this matter all the way to the top - but I don't. So please

do

> your part, file a complaint today. I did, even though we won our

> appeal. My insurance company worte a very misleading denial letter

> that stated we were denied because the " band did not

improve/correct

> a bodily function.. " When I looked up my benefits in my policy

book,

> under the durable medical equipment section, that phrase

> continued " or further prevents the deterioration of the medical

> condition. " They had purposefully left out that phrase so that

they

> could say the band is not a covered expense. Our craniofacial

doctor

> had clearly stated in his medical necessity letter that our

daughter

> faces TMJ, ear, and orbit problems if her plagiocephaly was not

> coorected - clearly a deterioration of the medical condition. I am

> sure this is not the first time insurance has played games and

> counted on the fact that 90% of denials are never appealled!

Please

> take action. Give some of your time to help future parents that

find

> themselves in the same pair of shoes. Sincerely, Avigale's mommy

>

> PS. We have been casted and expect to be fitted with the band in

the

> next few days. Please pray that when the band comes in, the

> thunderstorms subside to make our 100 mile trip safe (We are in

Texas

> and it has been a continuous thunderstorm for the month of June!)

[Guest guest]

Gale,

It may also be of interest to those fighting for insurance coverage

that two bills were introduced last year in Congress (one in the

House, one in the senate) that would require insurance coverage for

treatment of a child's deformity even if correcting that deformity

doesn't return a function of some sort - sounds like they are aware

of this denial reason, and are trying to address it with this bill.

Although now we are in the 2nd session of the 108th congress, I'm

not sure, but the bills may have to be re-introduced. You can

follow these links to find out the wording of the bill, as well as

check to see if your state senator or representative signed on as co-

sponsor to support this bill. Pressure on elected officials in

support of a bill like this may help to get it passed. Here are the

links (if they are over one line long, you may need to copy and

paste the entire link to get directed correctly):

House of Representatives Bill # H. R. 296 Status " Treatment of

Children's Deformaties Act of 2003 "

Check here to see the latest action that has been taken on this bill

currently in the House of Representatives.

http://www.congress.org/congressorg/issues/bills/?

billnum=H.R.296 & congress=108 & size=full

House of Representatives Bill # H.R. 296 " Treatment of Children's

Deformities Act of 2003 "

Read the details of this House of Representatives bill proposal

requiring insurance companies to cover correction of deformities

even if function is not restored.

http://www.congress.org/congressorg/webreturn/?

url=http://thomas.loc.gov/cgi-bin/query/z?c108:H.R.296:

Senate Bill # S. 977 Status: " Treatment of Children's Deformities

Act of 2003 "

Read here to see the latest major action that has happened to this

Bill in the Senate.

http://thomas.loc.gov/cgi-bin/bdquery/z?d108:SN00977:@@@X

Senate Bill # S. 977 " Treatment of Children's Deformities Act of

2003 "

Read the details of this Senate bill proposal requiring insurance

companies to cover correction of deformities even if function is not

restored in the process.

http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?

dbname=108_cong_bills & docid=f:s977is.txt.pdf

Also, for any members in New Jersey, we have heard from another

group member in NJ that State Assemblywoman Quigley is working to

introduce legislation in her state to cover cranial orthoses. I

haven't heard an update in a while, but here is the link to her site:

New Jersey State Assemblywoman Joan Quigley's website

Later this spring 2004, she will be introducing a bill to mandate

insurance coverage for plagio, etc. Hopefully, this bill will be

posted on her website when it is introduced.

http://www.njleg.state.nj.us/members/quigley.asp

These might be some other avenues for personally getting in the

fight for insurance coverage that may appeal to some.

Take care, and I'm very glad you brought up this point,

Christie (Mom to Repo'd Remy)

> Hello everyone,

>

> I want to encourage ALL of you to take a stand against the

insurance

> companies. Being a mom myself, I know how much time it takes to

be a

> mommy. However, we need to band together to try to make getting

> these bands easier. If your insurance company made you appeal for

> coverage or flat out denied you, please contact your state

insurance

> company ASAP. You can find the address and information via the

> internet, very easily. Some complaints can be filed over the

> internet. My insurance company denied our first claim so we went

> through the appeals process to finally get it covered. It was

> extremely stressful. Parents should not have to fight insurance

(who

> they pay) to get their children a band. I wish I have more time

to

> take this matter all the way to the top - but I don't. So please

do

> your part, file a complaint today. I did, even though we won our

> appeal. My insurance company worte a very misleading denial

letter

> that stated we were denied because the " band did not

improve/correct

> a bodily function.. " When I looked up my benefits in my policy

book,

> under the durable medical equipment section, that phrase

> continued " or further prevents the deterioration of the medical

> condition. " They had purposefully left out that phrase so that

they

> could say the band is not a covered expense. Our craniofacial

doctor

> had clearly stated in his medical necessity letter that our

daughter

> faces TMJ, ear, and orbit problems if her plagiocephaly was not

> coorected - clearly a deterioration of the medical condition. I

am

> sure this is not the first time insurance has played games and

> counted on the fact that 90% of denials are never appealled!

Please

> take action. Give some of your time to help future parents that

find

> themselves in the same pair of shoes. Sincerely, Avigale's mommy

>

> PS. We have been casted and expect to be fitted with the band in

the

> next few days. Please pray that when the band comes in, the

> thunderstorms subside to make our 100 mile trip safe (We are in

Texas

> and it has been a continuous thunderstorm for the month of June!)

[Guest guest]

Thank you so much for this information!!!!! It is so wonderful. I just

forwarded this to 's mom who is having trouble with her

insurance!!!

Krissy

ph's mom

Starband4/28/04

Palm Harbor, FL

On Jun 30, 2004, at 11:50 AM, redlocks2003 wrote:

> Gale,

>

> It may also be of interest to those fighting for insurance coverage

> that two bills were introduced last year in Congress (one in the

> House, one in the senate) that would require insurance coverage for

> treatment of a child's deformity even if correcting that deformity

> doesn't return a function of some sort - sounds like they are aware

> of this denial reason, and are trying to address it with this bill.

> Although now we are in the 2nd session of the 108th congress, I'm

> not sure, but the bills may have to be re-introduced. You can

> follow these links to find out the wording of the bill, as well as

> check to see if your state senator or representative signed on as co-

> sponsor to support this bill. Pressure on elected officials in

> support of a bill like this may help to get it passed. Here are the

> links (if they are over one line long, you may need to copy and

> paste the entire link to get directed correctly):

>

> House of Representatives Bill # H. R. 296 Status " Treatment of

> Children's Deformaties Act of 2003 "

> Check here to see the latest action that has been taken on this bill

> currently in the House of Representatives.

> http://www.congress.org/congressorg/issues/bills/?

> billnum=H.R.296 & congress=108 & size=full

>

> House of Representatives Bill # H.R. 296 " Treatment of Children's

> Deformities Act of 2003 "

> Read the details of this House of Representatives bill proposal

> requiring insurance companies to cover correction of deformities

> even if function is not restored.

> http://www.congress.org/congressorg/webreturn/?

> url=http://thomas.loc.gov/cgi-bin/query/z?c108:H.R.296:

>

> Senate Bill # S. 977 Status: " Treatment of Children's Deformities

> Act of 2003 "

> Read here to see the latest major action that has happened to this

> Bill in the Senate.

> http://thomas.loc.gov/cgi-bin/bdquery/z?d108:SN00977:@@@X

>

> Senate Bill # S. 977 " Treatment of Children's Deformities Act of

> 2003 "

> Read the details of this Senate bill proposal requiring insurance

> companies to cover correction of deformities even if function is not

> restored in the process.

> http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?

> dbname=108_cong_bills & docid=f:s977is.txt.pdf

>

>

> Also, for any members in New Jersey, we have heard from another

> group member in NJ that State Assemblywoman Quigley is working to

> introduce legislation in her state to cover cranial orthoses. I

> haven't heard an update in a while, but here is the link to her site:

>

> New Jersey State Assemblywoman Joan Quigley's website

> Later this spring 2004, she will be introducing a bill to mandate

> insurance coverage for plagio, etc. Hopefully, this bill will be

> posted on her website when it is introduced.

> http://www.njleg.state.nj.us/members/quigley.asp

>

> These might be some other avenues for personally getting in the

> fight for insurance coverage that may appeal to some.

>

> Take care, and I'm very glad you brought up this point,

>

> Christie (Mom to Repo'd Remy)

>

>

>

>

>

>> Hello everyone,

>>

>> I want to encourage ALL of you to take a stand against the

> insurance

>> companies. Being a mom myself, I know how much time it takes to

> be a

>> mommy. However, we need to band together to try to make getting

>> these bands easier. If your insurance company made you appeal for

>> coverage or flat out denied you, please contact your state

> insurance

>> company ASAP. You can find the address and information via the

>> internet, very easily. Some complaints can be filed over the

>> internet. My insurance company denied our first claim so we went

>> through the appeals process to finally get it covered. It was

>> extremely stressful. Parents should not have to fight insurance

> (who

>> they pay) to get their children a band. I wish I have more time

> to

>> take this matter all the way to the top - but I don't. So please

> do

>> your part, file a complaint today. I did, even though we won our

>> appeal. My insurance company worte a very misleading denial

> letter

>> that stated we were denied because the " band did not

> improve/correct

>> a bodily function.. " When I looked up my benefits in my policy

> book,

>> under the durable medical equipment section, that phrase

>> continued " or further prevents the deterioration of the medical

>> condition. " They had purposefully left out that phrase so that

> they

>> could say the band is not a covered expense. Our craniofacial

> doctor

>> had clearly stated in his medical necessity letter that our

> daughter

>> faces TMJ, ear, and orbit problems if her plagiocephaly was not

>> coorected - clearly a deterioration of the medical condition. I

> am

>> sure this is not the first time insurance has played games and

>> counted on the fact that 90% of denials are never appealled!

> Please

>> take action. Give some of your time to help future parents that

> find

>> themselves in the same pair of shoes. Sincerely, Avigale's mommy

>>

>> PS. We have been casted and expect to be fitted with the band in

> the

>> next few days. Please pray that when the band comes in, the

>> thunderstorms subside to make our 100 mile trip safe (We are in

> Texas

>> and it has been a continuous thunderstorm for the month of June!)

>

>

>

>

> For more plagio info

[Guest guest]

Hi there,

I totally agree with you. I believe it is up to us to get

the message across that we will no longer let the insurance companies

ignore the obvious...that plagio is a problem that deserves

treatment! BCBS of Texas not only denies coverage of the band but

they also exclude PT for Torticollis and treatment for TMJ!!! They

will however pay for surgery to release the muscle causing the

tort....weird and crazy huh!!!

(mom to , Plagio/Brachy/Tort, banded 5/03,Texas)

> Hello everyone,

>

> I want to encourage ALL of you to take a stand against the

insurance

> companies. Being a mom myself, I know how much time it takes to be

a

> mommy. However, we need to band together to try to make getting

> these bands easier. If your insurance company made you appeal for

> coverage or flat out denied you, please contact your state

insurance

> company ASAP. You can find the address and information via the

> internet, very easily. Some complaints can be filed over the

> internet. My insurance company denied our first claim so we went

> through the appeals process to finally get it covered. It was

> extremely stressful. Parents should not have to fight insurance

(who

> they pay) to get their children a band. I wish I have more time to

> take this matter all the way to the top - but I don't. So please

do

> your part, file a complaint today. I did, even though we won our

> appeal. My insurance company worte a very misleading denial letter

> that stated we were denied because the " band did not

improve/correct

> a bodily function.. " When I looked up my benefits in my policy

book,

> under the durable medical equipment section, that phrase

> continued " or further prevents the deterioration of the medical

> condition. " They had purposefully left out that phrase so that

they

> could say the band is not a covered expense. Our craniofacial

doctor

> had clearly stated in his medical necessity letter that our

daughter

> faces TMJ, ear, and orbit problems if her plagiocephaly was not

> coorected - clearly a deterioration of the medical condition. I am

> sure this is not the first time insurance has played games and

> counted on the fact that 90% of denials are never appealled!

Please

> take action. Give some of your time to help future parents that

find

> themselves in the same pair of shoes. Sincerely, Avigale's mommy

>

> PS. We have been casted and expect to be fitted with the band in

the

> next few days. Please pray that when the band comes in, the

> thunderstorms subside to make our 100 mile trip safe (We are in

Texas

> and it has been a continuous thunderstorm for the month of June!)