Re: HELP! Got United Healthcare Denial Today

[Guest guest]

Hi ,

Welcome to the group. Unfortunately it seems to me UHC always denies,

and pays only on appeal (and not all appeals). I would definitely get

the process started. We were lucky that our insurance covered our

starband 100% upfront - pretty unusual. My daughter had brachy (flat

in back) and did very well in her band.

-christine

sydney 2 yrs starband grad

>

>

> Hi!

>

> My name is and I am new to this group. I live in Atlanta with

my daughter, Margot (3), and my baby boy, Brody. My almost 5 month

old son was diagnosed with plagiocephaly about a week ago.

>

> I have done some research on the internet and I've learned more

about the STARBAND helmet than I ever thought I would learn! I

quickly found out that United Healthcare is known for denying coverage

for this diagnosis which to me is absolutely crazy. So...after the

orthodist at Children's Healthcare of Atlanta measured him and

recommended a helmet I took him to our pediatrian. Our pediatrician

(who tends to be pretty conservative) said " if this was my baby I

would get him the helmet. " So...I got the doctor to write a letter of

medical necessity. The letter noted that this plagiocephaly was

caused from his position inutero and he has left pinnia ear deformity

and category 4 plagio with left anterior ear shifting, occipital

flattening and frontal bossing, and right frontal and parietal

flattening. His cranial vault index value was 8.9 and his actual

asymmetry discrepancy was 13.4 mm. It also noted that we have been

trying repositioning since birth with no improvement of the flattening

of the skull. I thought the letter was pretty convincing and UH

wouldn't deny covering it. Well....I got the letter denying coverage

today.

>

> HELP!!!!!! Can someone please give me guidance in the most

effective way to go about handling this? I am definitely going to

appeal (with a vengenace) and thought some experienced parents might

be able to help. I really appreciate any guidance you can provide.

>

> Thank you!

> Shields

> Brody's mom

>

>