Re: Appeal denied...what to do next?

[Guest guest]

Sorry you were denied again ! I never had to do an appeal,

so I'm no help, but hopefully someone will have some good advice for

you! Keep us posted.

, mom to Hannah, DOCgrad

Cape Cod, Ma

>

> My insurance company called this morning to let me know that they

> once again denied my claim. This time they denied it b/c they

said

> there wasn't a current functioning problem. How am I going to

appeal

> to that? I guess my next step is to appeal to NYS.

> Just wondering if anyone had any thoughts or factual information

that

> will help me with this.

> Honestly....there really isn't a functioning problem " right now " ,

> and that is their response.

>

> So aggravated and frustrated!! Luckily we started when we did

with

> the STARband and didnt' wait for the insurance. We are already

> almost 2 months into it and seeing great progress.

>

> Thanks everyone...you have all been so helpful so far in this

> process!

>

>

> Mom to 8months (STARBAND 10/18)

[Guest guest]

Hello

, 's Mom is the guru in appeals. She is currently taking

her son's insurance to court. She has said that anyone needing help

is more than welcome to email her.

Her email is Sugrill@ juno.com , just leave out the space

Sandy Willow's Mom

Torticollis resolved

Cranio Germany Grad

>

> My insurance company called this morning to let me know that they

> once again denied my claim. This time they denied it b/c they

said

> there wasn't a current functioning problem. How am I going to

appeal

> to that? I guess my next step is to appeal to NYS.

> Just wondering if anyone had any thoughts or factual information

that

> will help me with this.

> Honestly....there really isn't a functioning problem " right now " ,

> and that is their response.

>

> So aggravated and frustrated!! Luckily we started when we did

with

> the STARband and didnt' wait for the insurance. We are already

> almost 2 months into it and seeing great progress.

>

> Thanks everyone...you have all been so helpful so far in this

> process!

>

>

> Mom to 8months (STARBAND 10/18)

[Guest guest]

I only have a second, but did I email you my letter? Oh wait - it's

on this website!! And YES, make an on-line claim to the NYS

Insurance Dept. i'll be able to help you more but I gotta run right

now.

Sue

>

> My insurance company called this morning to let me know that they

> once again denied my claim. This time they denied it b/c they said

> there wasn't a current functioning problem. How am I going to

appeal

> to that? I guess my next step is to appeal to NYS.

> Just wondering if anyone had any thoughts or factual information

that

> will help me with this.

> Honestly....there really isn't a functioning problem " right now " ,

> and that is their response.

>

> So aggravated and frustrated!! Luckily we started when we did with

> the STARband and didnt' wait for the insurance. We are already

> almost 2 months into it and seeing great progress.

>

> Thanks everyone...you have all been so helpful so far in this

> process!

>

>

> Mom to 8months (STARBAND 10/18)

[Guest guest]

Hey Sue!

I should give you my other email LOL!! Just got it tonight!

I didn't read your appeal....I don't think you sent it. I will go

check it out on this site but ANY info you can give me or help me

with would be GREATLY appreciated!!

Should I make the claim once I get my denial stuff? Should I try to

get more factual info before I appeal again? This is really a pain

in the butt. It's really not even about the money....I just feel

that they are wrong.

> >

> > My insurance company called this morning to let me know that they

> > once again denied my claim. This time they denied it b/c they

said

> > there wasn't a current functioning problem. How am I going to

> appeal

> > to that? I guess my next step is to appeal to NYS.

> > Just wondering if anyone had any thoughts or factual information

> that

> > will help me with this.

> > Honestly....there really isn't a functioning problem " right

now " ,

> > and that is their response.

> >

> > So aggravated and frustrated!! Luckily we started when we did

with

> > the STARband and didnt' wait for the insurance. We are already

> > almost 2 months into it and seeing great progress.

> >

> > Thanks everyone...you have all been so helpful so far in this

> > process!

> >

> >

> > Mom to 8months (STARBAND 10/18)

[Guest guest]

Thank you Sandy:)

I just emailed her!!

> >

> > My insurance company called this morning to let me know that they

> > once again denied my claim. This time they denied it b/c they

> said

> > there wasn't a current functioning problem. How am I going to

> appeal

> > to that? I guess my next step is to appeal to NYS.

> > Just wondering if anyone had any thoughts or factual information

> that

> > will help me with this.

> > Honestly....there really isn't a functioning problem " right

now " ,

> > and that is their response.

> >

> > So aggravated and frustrated!! Luckily we started when we did

> with

> > the STARband and didnt' wait for the insurance. We are already

> > almost 2 months into it and seeing great progress.

> >

> > Thanks everyone...you have all been so helpful so far in this

> > process!

> >

> >

> > Mom to 8months (STARBAND 10/18)

[Guest guest]

,

Make a complaint to the NYS Ins. Dept. now using this online form.

There is no charge. Who is saying there is a $50 charge?:

https://www.secure03.ins.state.ny.us/webproxy/proxy/complaint/0/StartF

orm.jsp

My HMO said I had to prove medical necessity which is pretty much

what yours is saying too, only you have to prove a functional

impairment exists now? Perhaps see if your ped (and was their a

specialist involved with getting your Rx for the helmet?) can help

you out. I didn't need any further help from an MD though. IMO you

could still win this yourself.

You already sent them the big letter and references? Then go to the

next level in their appeal process. Mine was an in-person internal

appeal mtg. What is yours - an external appeal? Feel free to e-mail

me privately if there is anything more that I can do. I would say

you just have to keep fighting and hopefully they will back down just

like ours did. I think that the claim to NYS really did help though.

Again free of charge....good luck!

Sue

> > > >

> > > > My insurance company called this morning to let me know that

> they

> > > > once again denied my claim. This time they denied it b/c

they

> > said

> > > > there wasn't a current functioning problem. How am I going

to

> > > appeal

> > > > to that? I guess my next step is to appeal to NYS.

> > > > Just wondering if anyone had any thoughts or factual

> information

> > > that

> > > > will help me with this.

> > > > Honestly....there really isn't a functioning problem " right

> > now " ,

> > > > and that is their response.

> > > >

> > > > So aggravated and frustrated!! Luckily we started when we

did

> > with

> > > > the STARband and didnt' wait for the insurance. We are

already

> > > > almost 2 months into it and seeing great progress.

> > > >

> > > > Thanks everyone...you have all been so helpful so far in this

> > > > process!

> > > >

> > > >

> > > > Mom to 8months (STARBAND 10/18)

[Guest guest]

,

My smart A%^ response back to them would be does everyone on HBP medicine have to prove a functional impariment? It's only an indicator of possible problems to come. Are they willing to bet he will have no functional or psychologial impairments later in life? Would they like to pay for surgery instead? Plagio is clearly an abnormality. If a person were burned but had no functional impairment wouldn't plastic surgery would be authorized to return the body part to normal (especially on the face).

Ok I'm preaching to the choir but I was trying to find a different angle to take.

mom to na

DOC Grad 2/04

SCSue <justsue5@...> wrote:

,Make a complaint to the NYS Ins. Dept. now using this online form. There is no charge. Who is saying there is a $50 charge?:https://www.secure03.ins.state.ny.us/webproxy/proxy/complaint/0/StartForm.jspMy HMO said I had to prove medical necessity which is pretty much what yours is saying too, only you have to prove a functional impairment exists now? Perhaps see if your ped (and was their a specialist involved with getting your Rx for the helmet?) can help you out. I didn't need any further help from an MD though. IMO you could still win this yourself.You already sent them the big letter and references? Then go to the next level in their appeal process. Mine was an in-person internal appeal

mtg. What is yours - an external appeal? Feel free to e-mail me privately if there is anything more that I can do. I would say you just have to keep fighting and hopefully they will back down just like ours did. I think that the claim to NYS really did help though. Again free of charge....good luck!Sue> > > > > > > > My insurance company called this morning to let me know that > they > > > > once again denied my claim. This time they denied it b/c they > > said > > > > there wasn't a current functioning problem. How am I going

to > > > appeal > > > > to that? I guess my next step is to appeal to NYS.> > > > Just wondering if anyone had any thoughts or factual > information > > > that > > > > will help me with this.> > > > Honestly....there really isn't a functioning problem "right > > now" , > > > > and that is their response.> > > > > > > > So aggravated and frustrated!! Luckily we started when we did > > with > > > > the STARband and didnt' wait for the insurance. We are already > > > > almost 2 months into it and seeing great progress.> > > > > > > > Thanks everyone...you have all been so helpful so far in this > > > > process! > > > > > > > > > > > > Mom to 8months

(STARBAND 10/18)For more plagio info