Guest guest Posted November 22, 2004 Report Share Posted November 22, 2004 Hi everyone. UHC approved my appeal for my son's DOC band. My case I think is different than those that have recently posted about their denied appeals. Ours was originally denied because there was no evidence of a functional impairment and they considered it cosmetic. It was a covered benefit if functional impairment was proven. So I got the neurosurgeon to write a letter specifying the ocular and oral dysfunction that my son was at risk for (per the UHC policy). This must have worked. I also cited the case of Bynum v. Cigna Healthcare of North Carolina (although the insurance company and state are different, the circumstances were the same). I also referenced the letter that is on one of the websites (maybe Cappkids?) where the New York State Insurance Commissioner reversed a UHC denial of DOC band. I'm not sure these really helped though. What I think helped was is that the UHC policy specifically states that the doctor must provide information that the infant falls into a high risk group and that functional impairment such as ocular and oral dysfunction may occur later because the persistence of the severe plagiocephaly. In my appeal letter I referenced the doctor's letter that was included in the appeal as well as referencing their policy and stated that we had now met their conditions to being a covered procedure. Hope this helps those that are fighting a denial based on cosmetic denial. Anne Marie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 22, 2004 Report Share Posted November 22, 2004 Yipee!!!!!!!!!!!!! I am so happy you won your appeal. Thanks for sharing your info to help others. Angie and Jenna(STAR grad) I won my appeal with UHC Hi everyone. UHC approved my appeal for my son's DOC band. My case I think is different than those that have recently posted about their denied appeals. Ours was originally denied because there was no evidence of a functional impairment and they considered it cosmetic. It was a covered benefit if functional impairment was proven. So I got the neurosurgeon to write a letter specifying the ocular and oral dysfunction that my son was at risk for (per the UHC policy). This must have worked. I also cited the case of Bynum v. Cigna Healthcare of North Carolina (although the insurance company and state are different, the circumstances were the same). I also referenced the letter that is on one of the websites (maybe Cappkids?) where the New York State Insurance Commissioner reversed a UHC denial of DOC band. I'm not sure these really helped though. What I think helped was is that the UHC policy specifically states that the doctor must provide information that the infant falls into a high risk group and that functional impairment such as ocular and oral dysfunction may occur later because the persistence of the severe plagiocephaly. In my appeal letter I referenced the doctor's letter that was included in the appeal as well as referencing their policy and stated that we had now met their conditions to being a covered procedure. Hope this helps those that are fighting a denial based on cosmetic denial. Anne MarieFor more plagio info Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 22, 2004 Report Share Posted November 22, 2004 Anne Marie....Congratulations on your insurance approval! That must be such a great weight off your shoulders. And thanks for sharing the information. It will be a great help to others. Becky ('s mom) in Pgh, PA > Hi everyone. UHC approved my appeal for my son's DOC band. My case I think is different than those that have recently posted about their denied appeals. Ours was originally denied because there was no evidence of a functional impairment and they considered it cosmetic. It was a covered benefit if functional impairment was proven. > > So I got the neurosurgeon to write a letter specifying the ocular and oral dysfunction that my son was at risk for (per the UHC policy). This must have worked. I also cited the case of Bynum v. Cigna Healthcare of North Carolina (although the insurance company and state are different, the circumstances were the same). I also referenced the letter that is on one of the websites (maybe Cappkids?) where the New York State Insurance Commissioner reversed a UHC denial of DOC band. I'm not sure these really helped though. > > What I think helped was is that the UHC policy specifically states that the doctor must provide information that the infant falls into a high risk group and that functional impairment such as ocular and oral dysfunction may occur later because the persistence of the severe plagiocephaly. In my appeal letter I referenced the doctor's letter that was included in the appeal as well as referencing their policy and stated that we had now met their conditions to being a covered procedure. > > Hope this helps those that are fighting a denial based on cosmetic denial. > > Anne Marie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 23, 2004 Report Share Posted November 23, 2004 Congratulations!!! Thank you so much for sharing this information. It may help others with UHC and other ins. as well! Great job!! Sue Colin F., 14 mos. STARband grad > Hi everyone. UHC approved my appeal for my son's DOC band. My case I think is different than those that have recently posted about their denied appeals. Ours was originally denied because there was no evidence of a functional impairment and they considered it cosmetic. It was a covered benefit if functional impairment was proven. > > So I got the neurosurgeon to write a letter specifying the ocular and oral dysfunction that my son was at risk for (per the UHC policy). This must have worked. I also cited the case of Bynum v. Cigna Healthcare of North Carolina (although the insurance company and state are different, the circumstances were the same). I also referenced the letter that is on one of the websites (maybe Cappkids?) where the New York State Insurance Commissioner reversed a UHC denial of DOC band. I'm not sure these really helped though. > > What I think helped was is that the UHC policy specifically states that the doctor must provide information that the infant falls into a high risk group and that functional impairment such as ocular and oral dysfunction may occur later because the persistence of the severe plagiocephaly. In my appeal letter I referenced the doctor's letter that was included in the appeal as well as referencing their policy and stated that we had now met their conditions to being a covered procedure. > > Hope this helps those that are fighting a denial based on cosmetic denial. > > Anne Marie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 23, 2004 Report Share Posted November 23, 2004 - I was denied for the exact same thing by UHC, however the denied my first appeal... I don't even think they looked at my appeal.. I even sent them the cinga lawsuit that you are referring to and my doctor letter of medical neccessity along with a letter that I got my the database that I elaborated on and I got a denial... -- In Plagiocephaly , ambramlage@c... wrote: > Hi everyone. UHC approved my appeal for my son's DOC band. My case I think is different than those that have recently posted about their denied appeals. Ours was originally denied because there was no evidence of a functional impairment and they considered it cosmetic. It was a covered benefit if functional impairment was proven. > > So I got the neurosurgeon to write a letter specifying the ocular and oral dysfunction that my son was at risk for (per the UHC policy). This must have worked. I also cited the case of Bynum v. Cigna Healthcare of North Carolina (although the insurance company and state are different, the circumstances were the same). I also referenced the letter that is on one of the websites (maybe Cappkids?) where the New York State Insurance Commissioner reversed a UHC denial of DOC band. I'm not sure these really helped though. > > What I think helped was is that the UHC policy specifically states that the doctor must provide information that the infant falls into a high risk group and that functional impairment such as ocular and oral dysfunction may occur later because the persistence of the severe plagiocephaly. In my appeal letter I referenced the doctor's letter that was included in the appeal as well as referencing their policy and stated that we had now met their conditions to being a covered procedure. > > Hope this helps those that are fighting a denial based on cosmetic denial. > > Anne Marie Quote Link to comment Share on other sites More sharing options...
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