Guest guest Posted February 15, 2008 Report Share Posted February 15, 2008 Did they change the reason for denial? If so, contact your State Insurance Agency./insurance commissioner and ask them if this is allowed in your state. Generally insurance companies have to stand by the first denial and can't suddenly change if information is given to refute the reason for the 1st denial. This may or may not be the case in your state, though. If they did not change the reason, you can still call your State Insurance Angency and ask questions -- they may be able to help direct you to what steps to take next. Do you have any more appeals left? National Insurance Commissioners http://www.naic.org/Mom to Quinn, born 11/99, DOCband grad 10/00 for scaphocephalic head shape>------- Original Message ------->From : White Mackey[mailto:nikki_chica22@...]>Sent :/ STRONG> 2/15/2008 6:06:38 PM>To : Plagiocephaly >Cc : >Subject : RE: 2nd Denial>>Help! We just got our second denial from UHC, based on orthotic appliances are excluded. Should I appeal again? I had an 8 page letter stating evidence, letter of medical necessity from the doctors, evidence to support it was necessary. HOW MUCH MORE OBVIOUS CAN IT BE??? Doesn't this completely go against some law somewhere, when insurance companies refuse to pay for treatment which is medically necessary? Help!For more plagio info Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 15, 2008 Report Share Posted February 15, 2008 Does your specific policy exclude orthotic devices? If so, then I really don't think (no matter how many appeals) that you'd win. We have UHC and were reimbursed 80% (as we thought we'd get from our policy). I agree with you that it is obvious that the band is medically necessary; however, I think the problem is that many insurance companies (along with doctors) think that this is a cosmetic issue and they don't view it as medically necessary. I'm not sure if you should appeal again or not. What was the reason for the first denial? > > > Did they change the reason for denial? > If so, contact your State Insurance Agency./insurance commissioner and ask them if this is allowed in your state. Generally insurance companies have to stand by the first denial and can't suddenly change if information is given to refute the reason for the 1st denial. This may or may not be the case in your state, though. > > If they did not change the reason, you can still call your State Insurance Angency and ask questions -- they may be able to help direct you to what steps to take next. Do you have any more appeals left? > > National Insurance Commissioners http://www.naic.org/ > > > Mom to Quinn, born 11/99, DOCband grad 10/00 for scaphocephalic head shape > > >------- Original Message ------- > >From : White Mackey[mailto:nikki_chica22@...] > >Sent : 2/15/2008 6:06:38 PM > >To : Plagiocephaly > >Cc : > >Subject : RE: 2nd Denial > > > >Help! We just got our second denial from UHC, based on orthotic > appliances are excluded. Should I appeal again? I had an 8 page > letter stating evidence, letter of medical necessity from the doctors, > evidence to support it was necessary. HOW MUCH MORE OBVIOUS CAN IT > BE??? Doesn't this completely go against some law somewhere, when > insurance companies refuse to pay for treatment which is medically > necessary? Help! > > > > For more plagio info Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 15, 2008 Report Share Posted February 15, 2008 If you have an exclusion - then I think that's it - that is excluded. Like when you have dental insurance and they exclude treatment for TMJ - you can't get them to pay for your TMJ. I may be wrong... hopefully if someone has successfully appealled an exclusion - they will speak up! Also, look thru old messages to see if anyone has posted about it in the past. Jen and Luli - 26 months Left tort - Right Plagio - Hanger Band Grad - CA http://www.babiesonline.com/babies/j/jens5th/ 2nd Denial Help! We just got our second denial from UHC, based on orthotic appliances are excluded. Should I appeal again? I had an 8 page letter stating evidence, letter of medical necessity from the doctors, evidence to support it was necessary. HOW MUCH MORE OBVIOUS CAN IT BE??? Doesn't this completely go against some law somewhere, when insurance companies refuse to pay for treatment which is medically necessary? Help! More new features than ever. Check out the new AOL Mail! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 17, 2008 Report Share Posted February 17, 2008 my insurance denied my sons helmet first but the orthotist took pictures of his head and sent them to insurance co for more proof..and he was then approved..ask your orthotist to send in pictures showing the severity of the babies head > > > > > > Did they change the reason for denial? > > If so, contact your State Insurance Agency./insurance commissioner > and ask them if this is allowed in your state. Generally insurance > companies have to stand by the first denial and can't suddenly > change if information is given to refute the reason for the 1st > denial. This may or may not be the case in your state, though. > > > > If they did not change the reason, you can still call your State > Insurance Angency and ask questions -- they may be able to help > direct you to what steps to take next. Do you have any more appeals > left? > > > > National Insurance Commissioners http://www.naic.org/ > > > > > > Mom to Quinn, born 11/99, DOCband grad 10/00 for scaphocephalic > head shape > > > > >------- Original Message ------- > > >From : White Mackey[ mailto:nikki_chica22@] > > >Sent : 2/15/2008 6:06:38 PM > > >To : Plagiocephaly > > >Cc : > > >Subject : RE: 2nd Denial > > > > > >Help! We just got our second denial from UHC, based on orthotic > > appliances are excluded. Should I appeal again? I had an 8 page > > letter stating evidence, letter of medical necessity from the > doctors, > > evidence to support it was necessary. HOW MUCH MORE OBVIOUS CAN IT > > BE??? Doesn't this completely go against some law somewhere, when > > insurance companies refuse to pay for treatment which is medically > > necessary? Help! > > > > > > > > For more plagio info Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 18, 2008 Report Share Posted February 18, 2008 for us it was weird, my son was measuring moderate to severe so definitely needed it but everyone (but us and experts) said they couildnt " see " it, the case worker approved it on measurements but when she got the pics she said he didnt look bad at all so i think for us just sending pics would have hurt us, measurements dided it for us, but most insurances approve at 9 or 10 and we had a 17 On Feb 17, 2008 3:29 PM, bobbiejoe04 <bobbiejoe04@...> wrote: my insurance denied my sons helmet first but the orthotist took pictures of his head and sent them to insurance co for more proof..and he was then approved..ask your orthotist to send in pictures showing the severity of the babies head > > > > > > Did they change the reason for denial? > > If so, contact your State Insurance Agency./insurance commissioner > and ask them if this is allowed in your state. Generally insurance > companies have to stand by the first denial and can't suddenly > change if information is given to refute the reason for the 1st > denial. This may or may not be the case in your state, though. > > > > If they did not change the reason, you can still call your State > Insurance Angency and ask questions -- they may be able to help > direct you to what steps to take next. Do you have any more appeals > left? > > > > National Insurance Commissioners http://www.naic.org/ > > > > > > Mom to Quinn, born 11/99, DOCband grad 10/00 for scaphocephalic > head shape> > > > >------- Original Message -------> > >From : White Mackey[ mailto:nikki_chica22@] > > >Sent : 2/15/2008 6:06:38 PM > > >To : Plagiocephaly > > >Cc : > > >Subject : RE: 2nd Denial> > >> > >Help! We just got our second denial from UHC, based on orthotic > > appliances are excluded. Should I appeal again? I had an 8 page > > letter stating evidence, letter of medical necessity from the > doctors, > > evidence to support it was necessary. HOW MUCH MORE OBVIOUS CAN IT > > BE??? Doesn't this completely go against some law somewhere, when > > insurance companies refuse to pay for treatment which is medically > > necessary? Help!> > > > > > > > For more plagio info Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 20, 2008 Report Share Posted February 20, 2008 This may be a long shot, but I read somewhere that if you can give names of patients that have been approved for the DOC band therapy that were previously denied for the same reason you were, you can appeal on discrimination. Our exclusion was based on " orthotic appliances that straighten or re-shape a body part (including some types of braces). So this is my request: if you were previously denied coverage from UHC based on this exclusion (or something similar) and were later covered, AND would like to give me your name and your child's name to use in another appeal letter, please email me. I would keep your names completely confidential and use them only for my letter, and then erase them. I know it's a long shot and some of you may not feel comfortable doing this, but we would really appreciate it if you could. Please email me so your info won't be on the web. Thanks! > > > > > > > > > > > > Did they change the reason for denial? > > > > If so, contact your State Insurance Agency./insurance > > commissioner > > > and ask them if this is allowed in your state. Generally insurance > > > companies have to stand by the first denial and can't suddenly > > > change if information is given to refute the reason for the 1st > > > denial. This may or may not be the case in your state, though. > > > > > > > > If they did not change the reason, you can still call your State > > > Insurance Angency and ask questions -- they may be able to help > > > direct you to what steps to take next. Do you have any more appeals > > > left? > > > > > > > > National Insurance Commissioners http://www.naic.org/ > > > > > > > > > > > > Mom to Quinn, born 11/99, DOCband grad 10/00 for scaphocephalic > > > head shape > > > > > > > > >------- Original Message ------- > > > > >From : White Mackey[ mailto:nikki_chica22@] > > > > >Sent : 2/15/2008 6:06:38 PM > > > > >To : Plagiocephaly <Plagiocephaly% 40> > > > > >Cc : > > > > >Subject : RE: 2nd Denial > > > > > > > > > >Help! We just got our second denial from UHC, based on orthotic > > > > appliances are excluded. Should I appeal again? I had an 8 page > > > > letter stating evidence, letter of medical necessity from the > > > doctors, > > > > evidence to support it was necessary. HOW MUCH MORE OBVIOUS CAN > > IT > > > > BE??? Doesn't this completely go against some law somewhere, when > > > > insurance companies refuse to pay for treatment which is > > medically > > > > necessary? Help! > > > > > > > > > > > > > > > > For more plagio info 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.