Re: Anyone want to help me fight United Healthcare. I am not giving up! :)

November 4, 2008

I give you all the luck in the world! I have UHC and didn't even try

to fight it because I've been told by EVERYONE that it's a lost cause!!!

~Kristi

>

> I have fought and appealed with United Healthcare 2 times and

> lost.They claim they can not cover my son's Doc Band because the

> clause specifically says " does not cover any orthotic that shpaes or

> molds a body part " . I have written a very very good appeal and

> brought up a ton of interesting facts on my son's condition and his

> band. So convincing they wanted to over turn it but simply couldn't.

> So sickening.

>

> I also encountered a huge problem with just finding out the info to

> attend the hearing " in person " but it took 15 different people and 4

> 1/2 hours on the phone to try and figure it out. I finally demanded

> the appeals department in which they claim no one gets the direct

> number to but I did. Then after all that I finally find out the

> hearing I can attend " in person " is really a teleconference up in

> Madison, an hour from my Milwaukee home, and alll you do is use

> United Healthcare's phone. How stupid. " In person " sounds like a

> board will be there to talk to " in person " . I felt like a right was

> taken from me. So since I had 2 hours till my deadline to let them

> know what I was going to do I took the teleconference at home. I was

> and still am fuming mad.

>

> So now I am pursuing higher methods such as going to all my local and

> state reps as well as other places. My father-in-law knows a ton of

> people in the local state government which will definitly help alot.

> I do not feel it is right for a company to help pay for Viagra but

> not my son's band. I am willing to help anyone, I mean anyone out

> there to try and win their appeal as well. I am also looking for

> anyone who also has United Healthcare so we can team up and battle

> them together. If we all ban together maybe we can change the system

> and take a stand for our babies who have no voice. I would really

> like to hear from anyon who wants to help or has advice etc. Please

> email me at Amyseymer@... I will try and get back to you as

> soon as possible. I do not have interent acess at home right now just

> at my jobs. Thank you in advance for your help it measn a ton to me

> and my 8 month old baby boy, Colton.

>

> Amy

>

> Ps. I have been trying to contact ppl on Cranialtech.com but I still

> have not been added into the system.

>

November 5, 2008

There actually are people who have won from UHC, but I don't know that

I've ever heard of them paying without appeal. Check the old messages

for the lucky " winners " :-)

-christine

sydney, almost 3 yrs, starband grad

> >

> > I have fought and appealed with United Healthcare 2 times and

> > lost.They claim they can not cover my son's Doc Band because the

> > clause specifically says " does not cover any orthotic that shpaes or

> > molds a body part " . I have written a very very good appeal and

> > brought up a ton of interesting facts on my son's condition and his

> > band. So convincing they wanted to over turn it but simply couldn't.

> > So sickening.

> >

> > I also encountered a huge problem with just finding out the info to

> > attend the hearing " in person " but it took 15 different people and 4

> > 1/2 hours on the phone to try and figure it out. I finally demanded

> > the appeals department in which they claim no one gets the direct

> > number to but I did. Then after all that I finally find out the

> > hearing I can attend " in person " is really a teleconference up in

> > Madison, an hour from my Milwaukee home, and alll you do is use

> > United Healthcare's phone. How stupid. " In person " sounds like a

> > board will be there to talk to " in person " . I felt like a right was

> > taken from me. So since I had 2 hours till my deadline to let them

> > know what I was going to do I took the teleconference at home. I was

> > and still am fuming mad.

> >

> > So now I am pursuing higher methods such as going to all my local and

> > state reps as well as other places. My father-in-law knows a ton of

> > people in the local state government which will definitly help alot.

> > I do not feel it is right for a company to help pay for Viagra but

> > not my son's band. I am willing to help anyone, I mean anyone out

> > there to try and win their appeal as well. I am also looking for

> > anyone who also has United Healthcare so we can team up and battle

> > them together. If we all ban together maybe we can change the system

> > and take a stand for our babies who have no voice. I would really

> > like to hear from anyon who wants to help or has advice etc. Please

> > email me at Amyseymer@ I will try and get back to you as

> > soon as possible. I do not have interent acess at home right now just

> > at my jobs. Thank you in advance for your help it measn a ton to me

> > and my 8 month old baby boy, Colton.

> >

> > Amy

> >

> > Ps. I have been trying to contact ppl on Cranialtech.com but I still

> > have not been added into the system.

> >

>

November 5, 2008

Thats not stopping me. I am going to make it my personal mission to help my baby as well as others get covered. I hate the fact they pay for stupid stuff but not my son! I will keep u updated!

From: nellyk_721 <nellyk_721@...>Subject: Re: Anyone want to help me fight United Healthcare. I am not giving up! Plagiocephaly Date: Tuesday, November 4, 2008, 10:26 PM

I give you all the luck in the world! I have UHC and didn't even tryto fight it because I've been told by EVERYONE that it's a lost cause!!! ~Kristi>> I have fought and appealed with United Healthcare 2 times and > lost.They claim they can not cover my son's Doc Band because the > clause specifically says "does not cover any orthotic that shpaes or > molds a body part". I have written a very very good appeal and > brought up a ton of interesting facts on my son's condition and his > band. So convincing they wanted to over turn it but simply couldn't. > So sickening.> > I also encountered a huge problem with just finding out the info to > attend the hearing "in person" but it took 15 different people and 4

> 1/2 hours on the phone to try and figure it out. I finally demanded > the appeals department in which they claim no one gets the direct > number to but I did. Then after all that I finally find out the > hearing I can attend "in person" is really a teleconference up in > Madison, an hour from my Milwaukee home, and alll you do is use > United Healthcare's phone. How stupid. "In person" sounds like a > board will be there to talk to "in person". I felt like a right was > taken from me. So since I had 2 hours till my deadline to let them > know what I was going to do I took the teleconference at home. I was > and still am fuming mad. > > So now I am pursuing higher methods such as going to all my local and > state reps as well as other places. My father-in-law knows a ton of > people in the local state government which will definitly help alot. > I

do not feel it is right for a company to help pay for Viagra but > not my son's band. I am willing to help anyone, I mean anyone out > there to try and win their appeal as well. I am also looking for > anyone who also has United Healthcare so we can team up and battle > them together. If we all ban together maybe we can change the system > and take a stand for our babies who have no voice. I would really > like to hear from anyon who wants to help or has advice etc. Please > email me at Amyseymer@.. . I will try and get back to you as > soon as possible. I do not have interent acess at home right now just > at my jobs. Thank you in advance for your help it measn a ton to me > and my 8 month old baby boy, Colton. > > Amy > > Ps. I have been trying to contact ppl on Cranialtech. com but I still > have not been added into the

system.>

November 6, 2008

I just mailed our first appeal to United HealthCare yesterday. Their

denial letter said that they will review it within 14 days of receipt.

I will let you all know of the outcome.

I checked their patient website (myuhc.com) for our policy and it

clearly stated that cranial orthotic devices ARE covered (varies by

policy) and my denial said that it was a specifically non-covered

item. Now does that make any sense at all? This is what our policy

states on the website:

" Cranial Orthotic Devices (DOC band) covered at 80% of eligible

expenses after satisfying $500 deductible

Allowed for the treatment for craniofacial asymmetry in infants 0-18

months of age with severe nonsynostotic positional plagiocephaly.

Severe nonsynostotic positional plagiocephaly defined in this policy

as an asymmetry of 10 mm or more in one of the following

anthropometric measures: cranial vault, skull base, or orbitotragial

depth; or a cephalic index of at least two standard deviations above

or below the mean for the appropriate gender/age. There is a limit of

2 procedures between 0- 18 months. "

We paid out of pocket and are looking to be reimbursed. I don't know

what your denial said, but check their website to see what the

coverage for Durable Medical Equipment is. Once you logon to their

site, go to " Benefits and Coverage " , then click on " Special Services "

and scroll down for Durable Medical Equipment. Best wishes on your

appeal!

BTW, the best information I've found for the appeals is cappskids.org.

Noel

mom to Dillon - Hanger helmet grad August 08!