Ins. denied Chiro, can anyone help w/ appeal letter?

[Guest guest]

Howdy,

It's no surprise that our insurance is only paying a frickin $63.00

for Jaden's insurance for his mild scoliosis (which is a result as a

birth injury I am thinking from suction), and the whole bill is over

$500 for 24 sessions. The chiro is giving us 12 sessions for free,

we pay for the first 12. We also have x-rays to prove the

scoliosis.

How do I appeal this w/ our insurance co, since Jaden was more than

likely injured at birth via suction and thus got tort and scoliosis

and plagio as a result? Anyone? I sure could use it!

Thanks.

~Amy, mommy to Jaden 7 mo's MN, plagio/mild tort/mild scoliosis,

started CranioCap 4/23/04, started Chiro 6/29/04

[Guest guest]

Amy,

I just wrote a whole big post to you but then I lost it. Argh!

I feel your pain. I wrote a letter using a template that I found on

this site. FILES/INSURANCE HELP/Appeal Letter.doc (I think that's

right) then I modified it. I deleted that part about definitions

(just a personal thing) and changed the paragraphs to reflect our

personal situation and clinical course of events. I found most

reference articles but not all so I should've left those out. Also

see plagiocephaly.org (Publications and Insurance Issues) for some

really good advice. It is ALOT of work but will be worth it if we

win. My internal appeal mtg is set for 7/15 (panel of dr.'s oh

yay). I hope that you do not have to go that far. Good luck

Sue

Colin F. 9 mos. brachy, rt plag, STARband 6/29

Buffalo, NY

--- In Plagiocephaly , " Amy in MN " <skisum88@h...>

wrote:

> Howdy,

> It's no surprise that our insurance is only paying a frickin $63.00

> for Jaden's insurance for his mild scoliosis (which is a result as

a

> birth injury I am thinking from suction), and the whole bill is

over

> $500 for 24 sessions. The chiro is giving us 12 sessions for free,

> we pay for the first 12. We also have x-rays to prove the

> scoliosis.

>

> How do I appeal this w/ our insurance co, since Jaden was more than

> likely injured at birth via suction and thus got tort and scoliosis

> and plagio as a result? Anyone? I sure could use it!

>

> Thanks.

>

> ~Amy, mommy to Jaden 7 mo's MN, plagio/mild tort/mild scoliosis,

> started CranioCap 4/23/04, started Chiro 6/29/04

[Guest guest]

By the way,

I just called the Ins Co and they said that the provider is " Out of

Network " services, and that basically the first $300 is out of

pocket, and then there is a $2000 deductible before they will pay

100%, otherwise it's only 70% after the forst $300 I believe.

Yikes. But this guy is the only one certified in my area to work on

Jaden since he is so young.

~Amy, Mommy to Jaden 7 mo's MN, yadda yadda yadda

--- In Plagiocephaly , " Amy in MN " <skisum88@h...>

wrote:

> Howdy,

> It's no surprise that our insurance is only paying a frickin

$63.00

> for Jaden's insurance for his mild scoliosis (which is a result as

a

> birth injury I am thinking from suction), and the whole bill is

over

> $500 for 24 sessions. The chiro is giving us 12 sessions for

free,

> we pay for the first 12. We also have x-rays to prove the

> scoliosis.

>

> How do I appeal this w/ our insurance co, since Jaden was more

than

> likely injured at birth via suction and thus got tort and

scoliosis

> and plagio as a result? Anyone? I sure could use it!

>

> Thanks.

>

> ~Amy, mommy to Jaden 7 mo's MN, plagio/mild tort/mild scoliosis,

> started CranioCap 4/23/04, started Chiro 6/29/04

[Guest guest]

I would still try to write a letter of justification for why you have

to go to this provider since he is within a reasonable distance and

is the only one that can provide the service. It's worth a shot. I

did this for wanting to use a facility that had a STARscanner and was

out-of-network. Again, pending descision...

Sue

> > Howdy,

> > It's no surprise that our insurance is only paying a frickin

> $63.00

> > for Jaden's insurance for his mild scoliosis (which is a result

as

> a

> > birth injury I am thinking from suction), and the whole bill is

> over

> > $500 for 24 sessions. The chiro is giving us 12 sessions for

> free,

> > we pay for the first 12. We also have x-rays to prove the

> > scoliosis.

> >

> > How do I appeal this w/ our insurance co, since Jaden was more

> than

> > likely injured at birth via suction and thus got tort and

> scoliosis

> > and plagio as a result? Anyone? I sure could use it!

> >

> > Thanks.

> >

> > ~Amy, mommy to Jaden 7 mo's MN, plagio/mild tort/mild scoliosis,

> > started CranioCap 4/23/04, started Chiro 6/29/04

[Guest guest]

Amy,

My insurance told us the same thing. I proved to them that there

was not an in-network provider competant to treatment my daughters

scaphy in the immediate area and rec'd full in-network benefits.

They paid 100$ with no co-pay or deductible. Good Luck!

Dustie

> > Howdy,

> > It's no surprise that our insurance is only paying a frickin

> $63.00

> > for Jaden's insurance for his mild scoliosis (which is a result

as

> a

> > birth injury I am thinking from suction), and the whole bill is

> over

> > $500 for 24 sessions. The chiro is giving us 12 sessions for

> free,

> > we pay for the first 12. We also have x-rays to prove the

> > scoliosis.

> >

> > How do I appeal this w/ our insurance co, since Jaden was more

> than

> > likely injured at birth via suction and thus got tort and

> scoliosis

> > and plagio as a result? Anyone? I sure could use it!

> >

> > Thanks.

> >

> > ~Amy, mommy to Jaden 7 mo's MN, plagio/mild tort/mild scoliosis,

> > started CranioCap 4/23/04, started Chiro 6/29/04