Re: I just DON'T understand!

[Guest guest]

Hi ,

From what I've heard, " exclusions " are harder (if not impossible) to

overturn on appeal. If you've got an exclusion for DME or helmets

specifically, you may not have any wiggle room. I would definitely

read your policy, though. UHC tried to tell me that they didn't

provide the " comprehensive " policy to clients b/c they

are " constantly changing coverage " . When I threatened to sue, I got

it within a week. You are entitled to that information by law.

Your policy may have generic wording or wording that is open to

interpretation. If so, I'd fight the denial.

But if you were told " cosmetic " on the phone, I don't think they can

change their mind on what they deny you for. Was your call

recorded? Do you have a log of the day/time/person you called? If

so, reference that in a letter and ask why the basis of denial has

changed. I'm not a lawyer or insurance expert (hardly!), but I've

also heard insurance companies can't do that.

GOOD LUCK!

Lori

Mom to , 8 1/2 months

DOC Band grad, July 07

>

> > I am appealing to UHC too. We went ahead and paid

> > the bill for

> > ours, knowing that UHC would deny coverage and it

> > would set my

> > daughter's treatment back. We proceeded with

> > therapy and it only

> > took 6 weeks...which I think would have been

> > extended had we decided

> > to wait for coverage, which may never have come. If

> > it were me, I'd

> > go ahead and try to pay for it and get reimbursed

> > later, if you

> > can. I don't regret our decision at all...

> >

> > I know for a fact that UHC has covered other

> > families for helmet

> > therapy, as is stated on some of the example appeal

> > letters on this

> > site. I just sent my appeal in last week so I don't

> > have an answer

> > yet, but if they don't approve the band I plan to

> > file a complaint

> > based on discrimination. I don't understand how

> > they could get away

> > with covering some families, but not others, when

> > the children have

> > the same daignoses and circumstances. We'll see

> > where I get.

> >

> > Also, I sent a copy of my appeal to our state

> > insurance

> > commissioner, both state senators and the state

> > medical

> > association. I figure that maybe one of them will

> > be able

> > to " influence " UHC. It may have been a waste of

> > time, but I figured

> > it was worth a shot. I am DETERMINED to make this

> > company do the

> > right thing. Just my idea, but I thought I'd share

> > it with you....

> >

> > Good luck to you...I'll keep my fingers crossed that

> > you get

> > coverage!

> >

> > Lori

> > Mom to , 8 1/2 months

> > DOC Band grad, July 07

> >

> >

>

>

>

>

>

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