United Health Care

[Guest guest]

We have UHC and so far what I have heard and what I have read is that

they typically deny claims. I know I can appeal, but I don't want to

hold off on treatment for my daughter just incase they appove it. I'd

also rather not have to appeal 3 times and have had months go by and

once they finally approve it the treament time is twice as long and

with the results not as good. IS there any positive feedback on United?

Should I just go ahead and pay for treatment out of pocket and hope and

wait they approve it? This is so stressful. It's not like a parent

would put their baby in a band for the hell of it, and I can't imagine

a doctor having a baby in one if they didn't need it.

[Guest guest]

I completely agree with you...it's not worth waiting to see if

they " might " approve it or not. I would definitely go ahead with

the treatment...we did and I have not regretted the decision. My

daughter's head is round and beautiful, and her facial asymmetries

have disappeared.

The insurance person I spoke with at CT in Dallas told me I'd run

into problems with UHC so she went ahead and sent them the pre-

approval paperwork (which you have to do if you plan to file with

insurance) and I proceeded with the helmet for my daughter.

We received a denial letter shortly after getting the band. I began

a 4 1/2 month process of researching and looking at others' example

appeal letters on this site and others. I finally submitted my 175

page appeal (including research articles) in September and I

received notification that they reversed the denial. Woo hoo! I

was told UHC probably wouldn't cover, even on appeal, but I'm proof

(along with several others on this site) that they will approve.

Just be persistent and thorough with your communication. Keep

records and don't send anything to them without return

receipt/delivery confimation/etc.

If you need access to some of the articles mentioned in the example

appeal letters on this site and have trouble finding them, let me

know...I have lots of them saved on disc and can email them to you.

They're hard to get a hold of (without paying) if you don't have

access to a University library. I posted my appeal letter in the

files section, in the insurance section if you're interested. Feel

free to use whatever you want from it...I used a little bit from

several of the letters I found on this board and I was so thankful

that I had them for reference.

Good luck to you...keep us posted and let us know how everything

works out!

Lori

Mom to , 9 months

DOC Band grad July 07

>

> We have UHC and so far what I have heard and what I have read is

that

> they typically deny claims. I know I can appeal, but I don't want

to

> hold off on treatment for my daughter just incase they appove it.

I'd

> also rather not have to appeal 3 times and have had months go by

and

> once they finally approve it the treament time is twice as long

and

> with the results not as good. IS there any positive feedback on

United?

> Should I just go ahead and pay for treatment out of pocket and

hope and

> wait they approve it? This is so stressful. It's not like a parent

> would put their baby in a band for the hell of it, and I can't

imagine

> a doctor having a baby in one if they didn't need it.

>

[Guest guest]

If you can (and will band regardless of UHC), then I would move

forward with the band (pay up front or do the payment plans) and

then appeal if you have to. We were going to band regardless of UHC

paying or not. We didn't want to have regrets. Fortunately, after

a 3 page appeal 1x we recieved 80% reimbursement (which is the

correct amount for our policy). It truly depends on your policy as

to whether or not they'll reimburse (and how much). If you send me

an email, I would be more than happy to send you our appeal. My

email is lka_236@...

>

> We have UHC and so far what I have heard and what I have read is

that

> they typically deny claims. I know I can appeal, but I don't want

to

> hold off on treatment for my daughter just incase they appove it.

I'd

> also rather not have to appeal 3 times and have had months go by

and

> once they finally approve it the treament time is twice as long

and

> with the results not as good. IS there any positive feedback on

United?

> Should I just go ahead and pay for treatment out of pocket and

hope and

> wait they approve it? This is so stressful. It's not like a parent

> would put their baby in a band for the hell of it, and I can't

imagine

> a doctor having a baby in one if they didn't need it.

>

[Guest guest]

I had also heard over and over that UHC typically denies claims. My

husband and I decided to go ahead with treatment with Cranial

Technologies. I felt like we really had to push CT to bill UHC, and CT

kept telling me UHC would deny the claim (at one point I had someone

from CT actually say to me, 'Are you going to do the band either way,

because if you are what difference does it make?' I told her it made a

lot of difference and I wasn't going to walk away from coverage if I

could get it--I was more frustrated with CT's approach than with UHC).

Well--my son has been in his band for five weeks now and last week I

received a notice from UHC that it had paid CT for the band! (I don't

know if I was just lucky, if our policy is different that those who

have been denied or if UHC is changing its position). It was an out-of-

network claim, so the payment wasn't the full amount, but I was happy

to get any coverage. My pediatrician has written an in-network

request, so we will submit that and see what we get. I just didn't

want to push my luck and I was happy that we got anything. I did call

UHC before we did the band and asked if it would cover orthodic devices

and they said yes. However, we can only use the claim for " orthodic

devices " once every three years. My son is about to outgrow his band

and we've decided not to do a second. We've been happy with the

correction he has gotten.

>

> We have UHC and so far what I have heard and what I have read is that

> they typically deny claims. I know I can appeal, but I don't want to

> hold off on treatment for my daughter just incase they appove it. I'd

> also rather not have to appeal 3 times and have had months go by and

> once they finally approve it the treament time is twice as long and

> with the results not as good. IS there any positive feedback on

United?

> Should I just go ahead and pay for treatment out of pocket and hope

and

> wait they approve it? This is so stressful. It's not like a parent

> would put their baby in a band for the hell of it, and I can't

imagine

> a doctor having a baby in one if they didn't need it.

>