RE: Domi [was got our second denial letter today]

[Guest guest]

Domi:

Did you send pictures showing how your baby laid with her chin going towards her chest, or other poses? Your case sounds exactly the same, (from descriptions that I've read before) as my son's, (in utero/breech/ etc.) and though CIGNA denied us once, they did approve us with our first appeal. Often insurance companies try to TIRE YOU OUT, and scare you into thinking that they won't cover.

In your baby's case, this happened IN UTERO so it is a CONGENITAL condition (you couldn't do anything to prevent it) -- and I'm very surprised that your appeal wasn't granted for this reason. You may want to take your letter to the drs. office that gave you the prescription and see if they can give you some advice on how to proceed for your next appeal. Including medical charts, etc. recording the size and head shape at birth can be another thing to include in your next appeal. Did you use the AMA's definition of "cosmetic" ("making it pretty") .vs reconstructive ("making it more normal")?

I know you are angry and upset, but don't give up. That is what they are expecting you to do.

Take care.

H.

(aka Kali, mom to Quinn (11/19/99) )

-----Original Message-----From: Dominika White [mailto:dominika@...]Sent: Wednesday, January 03, 2001 3:13 PMPlagiocephalyegroupsSubject: got our second denial letter todayI am sooo upset right now...I sent CIGNA a 10 page letter...numerousarticles supporting DOC bands and helmets...yet Mr. Nader still denies theclaim....can anyone help me? Ughhh....the frustration I feel right now isoverwhelming. I did want to thank you all for your help in writing theoriginal letter....all your letters had helped me tremedously. Thankyou!!!!Domi and Aimee

[Guest guest]

I used everything I could get my hands on....I used your letter as an example and used many of the same articles if I was able to locate them on the internet....i used other parts of peoples letters to help me and yet nothing...I don't know what to do....sigh.....CIGNA is really trying to wear me out....The initial denial came before casting for the helmet...and then today the appeal letter denial came...they basically told us the same thing only worded it differently. I am definately going to call my pediatrician about this and have him take a look at the letter....I am still shocked that they didn't cover....it breaks my heart......sigh...oh well.....we'll chug on.....Thank you for your advise...I am def. taking it to heart!!!

Domi and Aimee (1yrs old on Friday)

----- Original Message -----

From: Kali

Plagiocephalyegroups

Sent: Wednesday, January 03, 2001 10:05 PM

Subject: RE: Domi [was got our second denial letter today]

Domi:

Did you send pictures showing how your baby laid with her chin going towards her chest, or other poses? Your case sounds exactly the same, (from descriptions that I've read before) as my son's, (in utero/breech/ etc.) and though CIGNA denied us once, they did approve us with our first appeal. Often insurance companies try to TIRE YOU OUT, and scare you into thinking that they won't cover.

In your baby's case, this happened IN UTERO so it is a CONGENITAL condition (you couldn't do anything to prevent it) -- and I'm very surprised that your appeal wasn't granted for this reason. You may want to take your letter to the drs. office that gave you the prescription and see if they can give you some advice on how to proceed for your next appeal. Including medical charts, etc. recording the size and head shape at birth can be another thing to include in your next appeal. Did you use the AMA's definition of "cosmetic" ("making it pretty") .vs reconstructive ("making it more normal")?

I know you are angry and upset, but don't give up. That is what they are expecting you to do.

Take care.

H.

(aka Kali, mom to Quinn (11/19/99) )

-----Original Message-----From: Dominika White [mailto:dominika@...]Sent: Wednesday, January 03, 2001 3:13 PMPlagiocephalyegroupsSubject: got our second denial letter todayI am sooo upset right now...I sent CIGNA a 10 page letter...numerousarticles supporting DOC bands and helmets...yet Mr. Nader still denies theclaim....can anyone help me? Ughhh....the frustration I feel right now isoverwhelming. I did want to thank you all for your help in writing theoriginal letter....all your letters had helped me tremedously. Thankyou!!!!Domi and Aimee