Appeal denial letter

[Guest guest]

Very interesting stuff - I'

[Guest guest]

Sorry, cut myself off before I finished!! I'm going to go check out the sight

you mentioned. Thanks for the information and good luck with your second

appeal.

Marci (Mom to )

Oklahoma

[Guest guest]

I recently received a first level denial letter from CIGNA of Florida

that said the " Technology Evaluation Center " studied cranial orthosis

for plagio without synostosis and concluded that there aren't enough

studies to support use of the orthosis. I found out yesterday that

this is actually the BLUE CROSS BLUE SHIELD TEC that did the study.

The wording of my letter is straight from the website

www.bcbs.com/healthprofessionals/tec_overview and the

assessment " cranial orthosis for PWS " is listed under " cutting edge

topics " . So one insurance co. is selling studies to the others to

use as support for denials. How clever! We're scheduled a second

level appeal in April. I have a feeling I'm not the only one getting

this garbage so I wanted to let people know where it is coming from.

[Guest guest]

I had to laugh when I read this post about the TEC Evaluation.I

stumbled on this in a search trying to find out more info to help my

appeal to my insurance company, which happened to be BCBS. While

going through the appeals process I asked the woman who had been

helping me at BCBS about this TEC Evaluation, to my surprise they

knew nothing about it.I did e-mail a person from that web site that

faxed me a short version of what the TEC Evaluation finally really

said. Basically all it says is that there is not enough info to

support, one way or the other, if Cranial Orthosis are helpful or

not.If I where you I would fight the Ins company to the bitter end.I

finally got mine to pay after submitting pictures of my daughters

head.The medical director looked at them once and said yes we need to

do something about this child's head, it is not normal!!! Goodluck.

Amy & Abigail