HELP! Got United Healthcare Denial Today

[Guest guest]

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

Plagiocephaly From: christineashok@...Date: Fri, 9 May 2008 18:18:52 +0000Subject: 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.> >> Make Windows Vista more reliable and secure with Windows Vista Service Pack 1. Learn more.