My insurance just denied coverage for helmets for my twins

[Guest guest]

Hi,

My 6 mo old twins needed helmets, one for brachy/plagio and one for

just plagio. Cigna PPO denied coverage because the twins didn't need

brain surgery. They said they only pay for helmets if there is brain

surgery first.

I'm surprised they didn't bring up the cosmetic angle yet.

Anyway, what's the best way to appeal? They said I can appeal.

Thanks

in California on Cobra Cigna PPO

[Guest guest]

I just went through this EXACT same thing with Cigna. Check their

coverage position. They denied mine for that, but their benefits book

didn't match their coverage position. There's a list of ways for them

to qualify if it's non-surgical.

Here's the link to their coverage position:

http://www.cigna.com/customer_care/healthcare_professional/coverage_posi

tions/medical/mm_0056_coveragepositioncriteria_cranial_orthotic_devices.

pdf

They approved mine after 4!! months and 3 denials and I got my son,

Austin measured yesterday. (Thankfully, his twin didn't need one). It

was a big huge mess. Just make sure you keep notes of who you talk to,

what was said and send EVERYTHING certified mail!!

Good Luck

R

I

>

> Hi,

>

> My 6 mo old twins needed helmets, one for brachy/plagio and one for

> just plagio. Cigna PPO denied coverage because the twins didn't need

> brain surgery. They said they only pay for helmets if there is brain

> surgery first.

>

> I'm surprised they didn't bring up the cosmetic angle yet.

>

> Anyway, what's the best way to appeal? They said I can appeal.

>

> Thanks

> in California on Cobra Cigna PPO

>