Re: Denied again- contract exclusion

[Guest guest]

Jen,

I don't know much about contract exclusions, but we are in the

process of fighting BC/BS of California. Have you tried getting

your (or your husband's) Human Resource Department involved? We did

and they helped alot in our fight. HR was so disgusted with BC/BS

that they got their Broker involved as well.

Good luck in your fight, I'll be thinking of you.

Jennie

's Mommy

DOC Band Grad

--- In Plagiocephaly , " emsar14 " <jengruber@...>

wrote:

>

> Hi Everyone,

>

> Well, we were denied by Humana for a second time. They are making

> this impossible to fight, since they will only say that it's a

> contract exclusion, therefore it's not covered and it doesn't

matter

> that it's medically necessary. How can you fight this? It's

> impossible! Has anyone had any luck fighting a contract

exclusion? I

> used the files and sent over 40 pages of documentation with no

luck.

> We have one last chance to appeal through a third party and the

State

> of Michigan, so I don't want to waste this chance.

>

> Any advice would be greatly appreciated!

>

> Jen

>

> Mom to (9 mos, banded 1/25/06) and Emma (4 years)

>

[Guest guest]

Jen,

I don't know much about contract exclusions, but we are in the

process of fighting BC/BS of California. Have you tried getting

your (or your husband's) Human Resource Department involved? We did

and they helped alot in our fight. HR was so disgusted with BC/BS

that they got their Broker involved as well.

Good luck in your fight, I'll be thinking of you.

Jennie

's Mommy

DOC Band Grad

--- In Plagiocephaly , " emsar14 " <jengruber@...>

wrote:

>

> Hi Everyone,

>

> Well, we were denied by Humana for a second time. They are making

> this impossible to fight, since they will only say that it's a

> contract exclusion, therefore it's not covered and it doesn't

matter

> that it's medically necessary. How can you fight this? It's

> impossible! Has anyone had any luck fighting a contract

exclusion? I

> used the files and sent over 40 pages of documentation with no

luck.

> We have one last chance to appeal through a third party and the

State

> of Michigan, so I don't want to waste this chance.

>

> Any advice would be greatly appreciated!

>

> Jen

>

> Mom to (9 mos, banded 1/25/06) and Emma (4 years)

>

[Guest guest]

Hi,

My husband's HR department is a joke. I actually worked in HR for 8

years so I've been able to handle most of this myself. I did

contact the broker who was able to find out that it was excluded for

cosmetic reasons, but Humana is flat out denying that to me. I have

an email from their own employee stating that. I guess I'm going to

have to use that in my fight when the state gets involved.

I never thought it would be this hard...

Jen

> >

> > Hi Everyone,

> >

> > Well, we were denied by Humana for a second time. They are

making

> > this impossible to fight, since they will only say that it's a

> > contract exclusion, therefore it's not covered and it doesn't

> matter

> > that it's medically necessary. How can you fight this? It's

> > impossible! Has anyone had any luck fighting a contract

> exclusion? I

> > used the files and sent over 40 pages of documentation with no

> luck.

> > We have one last chance to appeal through a third party and the

> State

> > of Michigan, so I don't want to waste this chance.

> >

> > Any advice would be greatly appreciated!

> >

> > Jen

> >

> > Mom to (9 mos, banded 1/25/06) and Emma (4 years)

> >

>

[Guest guest]

Hi,

My husband's HR department is a joke. I actually worked in HR for 8

years so I've been able to handle most of this myself. I did

contact the broker who was able to find out that it was excluded for

cosmetic reasons, but Humana is flat out denying that to me. I have

an email from their own employee stating that. I guess I'm going to

have to use that in my fight when the state gets involved.

I never thought it would be this hard...

Jen

> >

> > Hi Everyone,

> >

> > Well, we were denied by Humana for a second time. They are

making

> > this impossible to fight, since they will only say that it's a

> > contract exclusion, therefore it's not covered and it doesn't

> matter

> > that it's medically necessary. How can you fight this? It's

> > impossible! Has anyone had any luck fighting a contract

> exclusion? I

> > used the files and sent over 40 pages of documentation with no

> luck.

> > We have one last chance to appeal through a third party and the

> State

> > of Michigan, so I don't want to waste this chance.

> >

> > Any advice would be greatly appreciated!

> >

> > Jen

> >

> > Mom to (9 mos, banded 1/25/06) and Emma (4 years)

> >

>

[Guest guest]

Sorry I didn't see your first post. I did successfully appeal a

contract exclusion, but as it turned out the insurance was working

off an old contract and it was supposed to be included. My appeal is

in the files section under contract exclusion. Use up all of your

appeal options. Call every day if you need to. We have found that

the squeaky wheel gets the oil.

na, DOC Grad Feb 04, Tort Resolved

Kiersten, DOC Band 1/10/06, Tort

www.thefilyaws.com

> > >

> > > Hi Everyone,

> > >

> > > Well, we were denied by Humana for a second time. They are

> making

> > > this impossible to fight, since they will only say that it's a

> > > contract exclusion, therefore it's not covered and it doesn't

> > matter

> > > that it's medically necessary. How can you fight this? It's

> > > impossible! Has anyone had any luck fighting a contract

> > exclusion? I

> > > used the files and sent over 40 pages of documentation with no

> > luck.

> > > We have one last chance to appeal through a third party and

the

> > State

> > > of Michigan, so I don't want to waste this chance.

> > >

> > > Any advice would be greatly appreciated!

> > >

> > > Jen

> > >

> > > Mom to (9 mos, banded 1/25/06) and Emma (4 years)

> > >

> >

>

[Guest guest]

Sorry I didn't see your first post. I did successfully appeal a

contract exclusion, but as it turned out the insurance was working

off an old contract and it was supposed to be included. My appeal is

in the files section under contract exclusion. Use up all of your

appeal options. Call every day if you need to. We have found that

the squeaky wheel gets the oil.

na, DOC Grad Feb 04, Tort Resolved

Kiersten, DOC Band 1/10/06, Tort

www.thefilyaws.com

> > >

> > > Hi Everyone,

> > >

> > > Well, we were denied by Humana for a second time. They are

> making

> > > this impossible to fight, since they will only say that it's a

> > > contract exclusion, therefore it's not covered and it doesn't

> > matter

> > > that it's medically necessary. How can you fight this? It's

> > > impossible! Has anyone had any luck fighting a contract

> > exclusion? I

> > > used the files and sent over 40 pages of documentation with no

> > luck.

> > > We have one last chance to appeal through a third party and

the

> > State

> > > of Michigan, so I don't want to waste this chance.

> > >

> > > Any advice would be greatly appreciated!

> > >

> > > Jen

> > >

> > > Mom to (9 mos, banded 1/25/06) and Emma (4 years)

> > >

> >

>

[Guest guest]

I actually used all of your files on my appeal, they were

wonderful. My doctor thought I was a genious but I couldn't take

the credit! At this point all I can do is write a letter to the

State and send them all of the other documentation for an external

review. After that our last resort is going to court, which I just

don't know if I can deal with. This whole contract exclusion thing

is insane. They know that the way they make it so general makes it

impossible to fight.

> > > >

> > > > Hi Everyone,

> > > >

> > > > Well, we were denied by Humana for a second time. They are

> > making

> > > > this impossible to fight, since they will only say that it's

a

> > > > contract exclusion, therefore it's not covered and it

doesn't

> > > matter

> > > > that it's medically necessary. How can you fight this?

It's

> > > > impossible! Has anyone had any luck fighting a contract

> > > exclusion? I

> > > > used the files and sent over 40 pages of documentation with

no

> > > luck.

> > > > We have one last chance to appeal through a third party and

> the

> > > State

> > > > of Michigan, so I don't want to waste this chance.

> > > >

> > > > Any advice would be greatly appreciated!

> > > >

> > > > Jen

> > > >

> > > > Mom to (9 mos, banded 1/25/06) and Emma (4 years)

> > > >

> > >

> >

>

[Guest guest]

I actually used all of your files on my appeal, they were

wonderful. My doctor thought I was a genious but I couldn't take

the credit! At this point all I can do is write a letter to the

State and send them all of the other documentation for an external

review. After that our last resort is going to court, which I just

don't know if I can deal with. This whole contract exclusion thing

is insane. They know that the way they make it so general makes it

impossible to fight.

> > > >

> > > > Hi Everyone,

> > > >

> > > > Well, we were denied by Humana for a second time. They are

> > making

> > > > this impossible to fight, since they will only say that it's

a

> > > > contract exclusion, therefore it's not covered and it

doesn't

> > > matter

> > > > that it's medically necessary. How can you fight this?

It's

> > > > impossible! Has anyone had any luck fighting a contract

> > > exclusion? I

> > > > used the files and sent over 40 pages of documentation with

no

> > > luck.

> > > > We have one last chance to appeal through a third party and

> the

> > > State

> > > > of Michigan, so I don't want to waste this chance.

> > > >

> > > > Any advice would be greatly appreciated!

> > > >

> > > > Jen

> > > >

> > > > Mom to (9 mos, banded 1/25/06) and Emma (4 years)

> > > >

> > >

> >

>

[Guest guest]

I can't take much credit either. I took bits and pieces from at

least 5-6 other appeal letters. This really is a great wealth of

knowledge we have on this site!!

na, DOC Grad Feb 04, Tort Resolved

Kiersten, DOC Band 1/10/06, Tort

www.thefilyaws.com

> > > > >

> > > > > Hi Everyone,

> > > > >

> > > > > Well, we were denied by Humana for a second time. They

are

> > > making

> > > > > this impossible to fight, since they will only say that

it's

> a

> > > > > contract exclusion, therefore it's not covered and it

> doesn't

> > > > matter

> > > > > that it's medically necessary. How can you fight this?

> It's

> > > > > impossible! Has anyone had any luck fighting a contract

> > > > exclusion? I

> > > > > used the files and sent over 40 pages of documentation

with

> no

> > > > luck.

> > > > > We have one last chance to appeal through a third party

and

> > the

> > > > State

> > > > > of Michigan, so I don't want to waste this chance.

> > > > >

> > > > > Any advice would be greatly appreciated!

> > > > >

> > > > > Jen

> > > > >

> > > > > Mom to (9 mos, banded 1/25/06) and Emma (4 years)

> > > > >

> > > >

> > >

> >

>

[Guest guest]

I can't take much credit either. I took bits and pieces from at

least 5-6 other appeal letters. This really is a great wealth of

knowledge we have on this site!!

na, DOC Grad Feb 04, Tort Resolved

Kiersten, DOC Band 1/10/06, Tort

www.thefilyaws.com

> > > > >

> > > > > Hi Everyone,

> > > > >

> > > > > Well, we were denied by Humana for a second time. They

are

> > > making

> > > > > this impossible to fight, since they will only say that

it's

> a

> > > > > contract exclusion, therefore it's not covered and it

> doesn't

> > > > matter

> > > > > that it's medically necessary. How can you fight this?

> It's

> > > > > impossible! Has anyone had any luck fighting a contract

> > > > exclusion? I

> > > > > used the files and sent over 40 pages of documentation

with

> no

> > > > luck.

> > > > > We have one last chance to appeal through a third party

and

> > the

> > > > State

> > > > > of Michigan, so I don't want to waste this chance.

> > > > >

> > > > > Any advice would be greatly appreciated!

> > > > >

> > > > > Jen

> > > > >

> > > > > Mom to (9 mos, banded 1/25/06) and Emma (4 years)

> > > > >

> > > >

> > >

> >

>