Guest guest Posted July 26, 2007 Report Share Posted July 26, 2007 OH ! I am so sorry!!! After a few days of reflection I guess you start getting any and all publications disputing each and every claim they made. THere are many articles out there proving the saftey and effectivness of the band. Look at it this way - they gave you a 1,2,3 list of everything you need to prove. YOU CAN DO IT!!!! I know it's a pain - but if you want it couvered - it can be done! Hang in there !!!! Jen and Luli - 19 mo. Left Tort - Right Plagio - Hanger Band Grad - CA tallulah jayne www.babiesonline.com/babies/j/jens5th/ got denied again! Well I got a big fat envelops in the mail today. It was 2, 42 pages, denial letters from TriCare. In the summary of the letters (which said the same thing) it says the reasons are "because such treatment has not been proven safe and effective, and comparable or superior to conventional care, for the treatment of functional impairment resulting from the beneficiary's diagnosed condition within the meaning of TRICARE regulation and policy. Furthermore, the PAP Orthosis represents noncovered cosmetic treatment since it restores from but does not correct of improve materially a bodily function." Everything I sent in they deputed. It pretty much said all the cases I sent in were not "controlled groups" or it was "bias". The letter stated that the helmets have a "potential negative health outcome", "there is no reliable evidence which establishes the efficacy of the DOC band or helmets as a compared to no treatment or standard treatment", "based on the lack of reliable evidence to establish that the use of the DOC Band or cranial molding helmets is safe, effective, and comparable or superior to standard treatment of plagiocephaly with out synostosis, this treatment is considered unproven." I guess my next step is appeal to a hearing. Has anyone done this before? Can anyone help me with this? I am really upset right now. I don't now what to do. Mom to Gwenith & Gilbert 12 months old P.A.P 1/06/07 Graduated 06/07/07 but back in them again 06/28/07 AOL now offers free email to everyone. Find out more about what's free from AOL at AOL.com. Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.