Re: [SPAM] HELP! Got United Healthcare Denial Today

[Guest guest]

Hi and Welcome to the group!

You are not alone with being denied by UHC. What was the specific reason for the denial? My denial was based on the fact that they don't cover orthodic devices that change the shape of a body part. Others have been denied due to the fact that UHC views bands as a cosmetic need and not a medical need. I can tell you this, a friend of mine works over at UHC. She says that 90% of the time, those that are processing claims don't even look at any sort of extra papers (i.e. letter of medical necessity.. etc) attached to the claim form. You could call and ask UHC to do another review of your claim. (they did that for me, but still denied) I would just start the appeal process. There are a lot of moms on this group that have research articles and examples of successful appeals. Depending on what your denial is based on, I could send you a copy of an example appeal that I used to write mine. Are you waiting to put your son in a band or have you already started the process?

Best of Luck

Lorie

Mom to Spencer and Alizabeth 1 yr

Spencer- Left Plagio- DOC Band GRAD 9/07-12/07

Glendale, AZ

Re: New to the group

My daughter didn't wear socks for 5 mo (the whole time in the band).Actually she started walking just before her graduation (10 mo old)and I took her out one time and realized the walking in public placeswas going to be a problem with no socks or shoes - so I had to run outand buy her shoes :-) They do get a little extra warm, but their body does adjust somewhatto their "hat".-christinesydney 2 yrs starband grad> >> > Hi - I'm also new to the group. My 6 month old son just got his DOC > > Band today. I voiced my concern for his head shape (to the > > pediatrician) when he was three months old and he said he wouldoutgrow > > it. He didn't. Apparently, it does clear up in 60% of children, but > > we weren't that lucky. After confirming the need with a neurosurgeon, > > we went ahead with Cranial Technologies (http://www.cranialtech.com) > > and we're optimistic that it will help. They have locationsthroughout > > the US and Spain. My only regret is that I didn't pursue it earlier.> >>

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[Guest guest]

Lorie,

Thanks so much for your response. The denial from UH was based on the "plan Exclusion Orthotic appliances that straighten or re-shape a body part" which I guess is what happened with yours, right? My husband and I assumed it would be denied (based on what I found on the internet) so we are proceeding with the helmet since our pediatrician really recommended it. I would LOVE to have a copy of your letter if you don't mind sharing. How much did they pay of yours?

Thanks!!!

Mom of Brody

Plagiocephaly From: lfitz_1@...Date: Fri, 9 May 2008 13:03:25 -0700Subject: Re: [sPAM] HELP! Got United Healthcare Denial Today

Hi and Welcome to the group!

You are not alone with being denied by UHC. What was the specific reason for the denial? My denial was based on the fact that they don't cover orthodic devices that change the shape of a body part. Others have been denied due to the fact that UHC views bands as a cosmetic need and not a medical need. I can tell you this, a friend of mine works over at UHC. She says that 90% of the time, those that are processing claims don't even look at any sort of extra papers (i.e. letter of medical necessity.. etc) attached to the claim form. You could call and ask UHC to do another review of your claim. (they did that for me, but still denied) I would just start the appeal process. There are a lot of moms on this group that have research articles and examples of successful appeals. Depending on what your denial is based on, I could send you a copy of an example appeal that I used to write mine. Are you waiting to put your son in a band or have you already started the process?

Best of Luck

Lorie

Mom to Spencer and Alizabeth 1 yr

Spencer- Left Plagio- DOC Band GRAD 9/07-12/07

Glendale, AZ

Re: New to the group

My daughter didn't wear socks for 5 mo (the whole time in the band).Actually she started walking just before her graduation (10 mo old)and I took her out one time and realized the walking in public placeswas going to be a problem with no socks or shoes - so I had to run outand buy her shoes :-) They do get a little extra warm, but their body does adjust somewhatto their "hat".-christinesydney 2 yrs starband grad> >> > Hi - I'm also new to the group. My 6 month old son just got his DOC > > Band today. I voiced my concern for his head shape (to the > > pediatrician) when he was three months old and he said he wouldoutgrow > > it. He didn't. Apparently, it does clear up in 60% of children, but > > we weren't that lucky. After confirming the need with a neurosurgeon, > > we went ahead with Cranial Technologies (http://www.cranialtech.com) > > and we're optimistic that it will help. They have locationsthroughout > > the US and Spain. My only regret is that I didn't pursue it earlier.> >>

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[Guest guest]

Hi Lorie!

I am curious if you might be willing to share that letter with me? I

have Tricare & I am pretty sure they will deny it as well.

> >> > Hi - I'm also new to the group. My 6 month old son just

got his DOC > > Band today. I voiced my concern for his head shape

(to the > > pediatrician) when he was three months old and he said

he wouldoutgrow > > it. He didn't. Apparently, it does clear up in

60% of children, but > > we weren't that lucky. After confirming the

need with a neurosurgeon, > > we went ahead with Cranial

Technologies (http://www.cranialtech.com) > > and we're optimistic

that it will help. They have locationsthroughout > > the US and

Spain. My only regret is that I didn't pursue it earlier.> >>

>

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