Guest guest Posted January 2, 2001 Report Share Posted January 2, 2001 I also consulted an attorney who specializes in HMO disputes. Since the cost of the locally made helmet is only $700 I do not have a large case. The attorney reccommended that I pursue a lawsuit in small claims court. In Oklahoma you can sue for up to $4500 in small claims court and if my Level 2 Appeals is denied (which I'm sure it will be) then I will MOST definately sue them in small claims court. I have two letters of medical necessity from my neurosurgeon and one from my pedicatrician and the insurance co. is still denying based on it is not medically necessar Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 2, 2001 Report Share Posted January 2, 2001 OOPs! Cut myself off in the middle of my email!!! Sorry!! Anyways I have kept VERY detailed journal entries and have every single thing that has been mailed, emailed or faxed since this all started organized in a notebook. The attorney said I would have a good chance in court. I would be very curious to hear how your meeting with your attorney goes. Please let me know!! Good luck!! Marci (Mom to ) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 2, 2001 Report Share Posted January 2, 2001 - Did you try having the doctor's office call your insurance company? My insurance co. said they wouldn't cover until I had my son's specialist call directly. I then had my rehab facility call the ins. co. and all has worked out--thank goodness! Good luck! -Cheryl ' mom 2/18/00; banded 12/15/00 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 3, 2001 Report Share Posted January 3, 2001 I am also on my second appeal to the Wellness Plan.(I live in Charlotte NC) I was told two weeks ago (At Cranial technologies) that Wellness approved payment of a band! (this happened in December - so there is hope!) I have researched and written up a plethera of information to Wellness. I will not give up! By the way - if you have a good attorney, please forward his name and telephone!!! Hang in there! Angie Pope Sales Representative, Pac-Van Leasing & Sales ----- Original Message ----- From: Meagan Palmer CT Sent: Sunday, December 31, 2000 2:31 AM Subject: Insurance coverage I'm new to this e-mail group. Hopefully I'll do this right the first time. My 9 month old daughter getting fitted for her second band next week. The Wellness Plan did not cover the first band and we are on the second level of appeal. I am also meeting with an attorney tomorrow to discuss other options. We have switched to CIGNA this year and it is my understanding that they will not cover either. Has anyone had any luck with these two insurance companies? Does anyone have any suggestions regarding legal action? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 4, 2001 Report Share Posted January 4, 2001 Hey Angie, I wasn't very encouraged today after my meeting with the attorney. He did find a "loophole" to argue in the second appeal but it has to do with the contractual agreement in the Membership Certificate as opposed to the medical necessity argument we originally argued. Basically, he would charge around $500 to write a letter on our behalf prior to the 2nd appeal hearing. It would cost between $1000 - $1500 for him to represent us at that hearing. Of course, no guarantees and there would be no consequences even if Wellness acknowledged the validity of his argument but still upheld their decision to deny the claim. If we were to take this to court, it could cost up to $10,000! I would love to talk with you more about this. How can I contact you? Are we allowed to leave phone numbers or addresses via e-mail? I live in Charlotte as well. Looking forward to hearing from you, Meagan Palmer ----- Original Message ----- From: Angie Pope Plagiocephalyegroups Sent: Wednesday, January 03, 2001 8:33 AM Subject: Re: Insurance coverage I am also on my second appeal to the Wellness Plan.(I live in Charlotte NC) I was told two weeks ago (At Cranial technologies) that Wellness approved payment of a band! (this happened in December - so there is hope!) I have researched and written up a plethera of information to Wellness. I will not give up! By the way - if you have a good attorney, please forward his name and telephone!!! Hang in there! Angie Pope Sales Representative, Pac-Van Leasing & Sales ----- Original Message ----- From: Meagan Palmer CT Sent: Sunday, December 31, 2000 2:31 AM Subject: Insurance coverage I'm new to this e-mail group. Hopefully I'll do this right the first time. My 9 month old daughter getting fitted for her second band next week. The Wellness Plan did not cover the first band and we are on the second level of appeal. I am also meeting with an attorney tomorrow to discuss other options. We have switched to CIGNA this year and it is my understanding that they will not cover either. Has anyone had any luck with these two insurance companies? Does anyone have any suggestions regarding legal action? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 4, 2001 Report Share Posted January 4, 2001 Cheryl, The specialist sent a very specific letter to Wellness outlining the medical reasons, to no avail. I will ask him if he will call personally though I'm not optimistic. He is one of the only MDs who prescribes in NC and is so busy I don't think that he wants to start a precedence. But I'll give it a try. Thanks, Meagan McCauley's mom - DOB 3/19/00 Banded 9/23/00 and again this month! ----- Original Message ----- From: <cheryl2V@...> <Plagiocephalyegroups> Sent: Tuesday, January 02, 2001 11:24 PM Subject: Re: Insurance coverage > - > Did you try having the doctor's office call your insurance company? My > insurance co. said they wouldn't cover until I had my son's specialist call > directly. I then had my rehab facility call the ins. co. and all has worked > out--thank goodness! > > Good luck! > > -Cheryl > ' mom 2/18/00; banded 12/15/00 > > Quote Link to comment Share on other sites More sharing options...
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