Guest guest Posted January 28, 2008 Report Share Posted January 28, 2008 This is what mine said (even though wording is a little different) " there is a lack of clinical evidence that the mild plagiocephaly described is causing physiologic functional impairment or is causing a significant risk for future functional impairment. A cranial orthotic will primarily change appearance by reshaping the head rather than improve physiologic function. Therefore, a cranial orthotic is a cosmetic service for this individual under the Plan is not a covered benefit. " I think how I came back to them was the 'long term affects of untreated plagio.' I would submit whatever info you have (i.e. measurements, etc.) Good luck. > > Hi Everyone, (Sorry this is kind of long) > UHC denied Spencer's claim for the DOC band. I just got the letter in the mail today and I am somewhat confused. It states: > " Based on the information provided, This service does not meet coverage requirments as defined in your plan. Therefore, no benefits are payable for this expense. In order for this service to be considered for coverage, you must submit medical recods that demonstrate a physiological functional impairment, along with an requirments indicated in your benefit plan language. " > So I check out my benfits package and it looks like they made this determination off of the " Reconstructive Procedures " Section > > Any advice? Has anyone else had this kind of denial letter? > > Thank you for your help. > > Lorie > Quote Link to comment Share on other sites More sharing options...
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