RE: Re: Re: Help!!! United Healthcare Denial

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One of the "penalties" for starting a medical process *before* a determination of denial or approval -- depending on your insurance and your policy - is that the insurance company can deny to pay the entire claim because of lack of procedure (that you didn't follow the appropriate procedure to get approval) -- and if you do indeed skip a step, and didn't try to get approval at first, then it's pretty hard to appeal this. Just be careful. mom to Quinn, born 11/99, DOCband graduate 10/00 for scaphcephalic headshape------- Original Message -------From : paola montealegre[mailto:paolamontealegre1@...]Sent : 4/16/2008 11:54:12 AMTo : Plagiocephaly Cc : Subject : RE: Re: Re: Help!!! United Healthcare Denial

I have a different insurance and covers 90% but they still need a prescription from my ped. I have an appointment with him today because it looks like he does not want to give us the prescription. Can you believe that? insurance covers but ped doesn't want to give ok. If that's the case I am going to change ped. When I asked the lady (insurance) from CT if we can start the process while we do the insurance paperwork so we don't waste time because we are going to a trip on july and want to finish with the band before that, she said that she has to check with the insurance because sometimes there are penalties for starting the treatment before they give the ok, so you better check before starting.

I am waiting but if the penaltie is not to high I probably pay it.

jrmcgrath71 <mcgrathjk@...> wrote:

We haven't filed our formal appeal yet. My employer is self insured, and United Healthcare is only the administrator of our insurance. I went to the head of our benefits department to see what she recommended we do, as in the end it is my employer that "pays" the bill. It has been a little over week, and I have't heard back yet. We already went ahead and paid for the band. He has been in it 3 weeks now. Things are going well.If anyone has any suggestions on how to get this paid please let us know.Thx,Jeff> >> > We received a denial from United Healthcare. It indicates "orthotic > > appliances that straighten or re-shape a body (including some sorts > of > > braces)" are excluded from coverage.> > > > Has any one had s

uccess in the appeals process with United Healthcare > > for this specific denial? Any help you could offer would be most > > appreciated.> > > > Thanks,> > > > Jeff> > Father to > > 8 months old> >>

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[Guest guest]

Wow. Thank you I din't know, now I am going to wait for their answer. <tnt@...> wrote: One of the "penalties" for starting a medical process *before* a determination of denial or approval -- depending on your insurance and your policy - is that the insurance company can deny to pay the entire claim because of lack of procedure (that you didn't follow the appropriate procedure to get approval) -- and if you do indeed skip a step, and didn't try to get approval at first, then it's

pretty hard to appeal this. Just be careful. mom to Quinn, born 11/99, DOCband graduate 10/00 for scaphcephalic headshape------- Original Message -------From : paola montealegre[mailto:paolamontealegre1 ]Sent : 4/16/2008 11:54:12 AMTo : Plagiocephaly Cc : Subject : RE: Re: Re: Help!!! United Healthcare Denial I have a different insurance and covers 90% but they still need a prescription from my ped. I have an appointment with him today because it looks like he does not want to give us the prescription. Can you believe that? insurance covers but ped doesn't want to give ok. If that's the case I am going to change ped. When I asked the lady (insurance) from CT if we can start the process while we do the insurance paperwork so we don't waste time

because we are going to a trip on july and want to finish with the band before that, she said that she has to check with the insurance because sometimes there are penalties for starting the treatment before they give the ok, so you better check before starting. I am waiting but if the penaltie is not to high I probably pay it. jrmcgrath71 <mcgrathjkfuse (DOT) net> wrote: We haven't filed our formal appeal yet. My employer is self insured, and United Healthcare is only the administrator of our insurance. I went to the head of our benefits department to see what she recommended we do, as in the end it is my employer that "pays" the bill. It has been a little over week, and I have't heard back yet. We already went ahead and paid for the

band. He has been in it 3 weeks now. Things are going well.If anyone has any suggestions on how to get this paid please let us know.Thx,Jeff> >> > We received a denial from United Healthcare. It indicates "orthotic > > appliances that straighten or re-shape a body (including some sorts > of > > braces)" are excluded from coverage.> > > > Has any one had s uccess in the appeals process with United Healthcare > > for this specific denial? Any help you could offer would be most > > appreciated.> > > > Thanks,> > > > Jeff> > Father to > > 8 months old> >> Be a better friend,

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