RE: apraxia as congenital anomaly: UHC

[Guest guest]

...My daughter's pediatician just wrote a letter based on medical necessity

to UHC. I don't think it will work. We don't have a diagnosis of apraxia

anyway. I didn't know it was a congenital anomaly. My grandson was premature,

had hypoxia from cord around his neck, hematoma from the vacuum, elevated white

blood count they believe to be from trauma because there was no infection,

apgar score of 2 at 1 min, 6 at 2min, 8 at 5 min, 30 min of critical care. He

was in NICU for a week, he didn't suck well so she came home from the hospital

with a rented breast pump and a green light thingy for jaundice. The

pediatrician was going to approach it from that point but he didn't do that

either. He basically just said it was medically necessary...unless maybe he

sent the birth records. Anyway...we haven't heard yet. It's crazy though

because awhile back I heard that UHC was offering $5000 grants to people who

needed help with speech costs because of their insurance not fully covering it.

I don't have the information anymore. At that time I thought his was covered.

That was what they told the Children's Hospital first and after 2 months of

paying they sent a letter saying it was a mistake and they want their money

back. Aggie

[ ] apraxia as congenital anomaly: UHC

Hi all -

So United Healthcare denied our claims AGAIN for speech therapy in the second

round of appeal, NOT on the basis of codes used but instead on the basis that

apraxia is does not fit their definition of " congenital anomaly " (never mind

that our submitted letters from Dr Marilyn Agin and Dr Abba Cargan - neurologist

- both said that it is). Has anyone else gone through this? If so, has anyone

successfully fought UHC? Advice is most welcome.

Thanks!

[Guest guest]

We are in the same boat..We tried the appeal with them and with different

procedure codes as per a UHC representative that was very sympathetic but it

also was rejected..I also feel this is a congenital anomaly and what more do

they want than the input from Dr. Agin and Dr Cargan?????

So frustrating.we even went back to my husbands employer (HR dept) as they

supposedly write the policy and they blamed it on UHC ..what I want to know

is who put congenital anomaly in the policy????

Roxanne

_____

From:

[mailto: ] On Behalf Of Turk

Sent: Monday, March 26, 2007 3:01 PM

Subject: [ ] apraxia as congenital anomaly: UHC

Hi all -

So United Healthcare denied our claims AGAIN for speech therapy in the

second round of appeal, NOT on the basis of codes used but instead on the

basis that apraxia is does not fit their definition of " congenital anomaly "

(never mind that our submitted letters from Dr Marilyn Agin and Dr Abba

Cargan - neurologist - both said that it is). Has anyone else gone through

this? If so, has anyone successfully fought UHC? Advice is most welcome.

Thanks!

[Guest guest]

You know, we did get coverage through United when our SLP at the

time filed the claims for us. I have no idea how she did it, but I

do know she got a single contact to deal with (who was a nurse) and

only worked with that person, and luckily she said this person was

sympathetic and helpful (and amazingly, worked for an insurance

company). I think this helped her figure out what United was

looking for. Sorry I can't be more help!

>

> Hi all -

> So United Healthcare denied our claims AGAIN for speech therapy in

the second round of appeal, NOT on the basis of codes used but

instead on the basis that apraxia is does not fit their definition

of " congenital anomaly " (never mind that our submitted letters from

Dr Marilyn Agin and Dr Abba Cargan - neurologist - both said that it

is). Has anyone else gone through this? If so, has anyone

successfully fought UHC? Advice is most welcome.

>

> Thanks!

>

>

>

[Guest guest]

After reading that Discover article that was posted a few days ago, I

wonder if there's a " chronic inflammation " type diagnosis that

insurance would pay for, and skirt the whole definition of Apraxia.

I don't know... just wondering aloud.

> >

> > Hi all -

> > So United Healthcare denied our claims AGAIN for speech therapy

in

> the second round of appeal, NOT on the basis of codes used but

> instead on the basis that apraxia is does not fit their definition

> of " congenital anomaly " (never mind that our submitted letters from

> Dr Marilyn Agin and Dr Abba Cargan - neurologist - both said that

it

> is). Has anyone else gone through this? If so, has anyone

> successfully fought UHC? Advice is most welcome.

> >

> > Thanks!

> >

> >

> >

[Guest guest]

I don't know how old your child is, and it might be to late to

completely change your reason codes anyway, and I'm sure each policy

is different..... but we were able to get coverage under UHC for ST

for a " Developmental Delay " because of a small little clause in our

policy. But it is only until 3 years old.

Crystal

>

> Hi all -

> So United Healthcare denied our claims AGAIN for speech therapy in

the second round of appeal, NOT on the basis of codes used but instead

on the basis that apraxia is does not fit their definition of

" congenital anomaly " (never mind that our submitted letters from Dr

Marilyn Agin and Dr Abba Cargan - neurologist - both said that it is).

Has anyone else gone through this? If so, has anyone successfully

fought UHC? Advice is most welcome.

>

> Thanks!

>

>

>

[Guest guest]

I don't know how old your child is, and it might be to late to

completely change your reason codes anyway, and I'm sure each policy

is different..... but we were able to get coverage under UHC for ST

for a " Developmental Delay " because of a small little clause in our

policy. But it is only until 3 years old.

Crystal

>

> Hi all -

> So United Healthcare denied our claims AGAIN for speech therapy in

the second round of appeal, NOT on the basis of codes used but instead

on the basis that apraxia is does not fit their definition of

" congenital anomaly " (never mind that our submitted letters from Dr

Marilyn Agin and Dr Abba Cargan - neurologist - both said that it is).

Has anyone else gone through this? If so, has anyone successfully

fought UHC? Advice is most welcome.

>

> Thanks!

>

>

>