Guest guest Posted February 7, 2002 Report Share Posted February 7, 2002 , So sorry to hear about your insurance problems, I can't believe they don't even let you appeal! What's up with that! Don't have anything helpful to say but just wanted to say good luck, you sound like great parents having a really tough time with the big insurance industry- nothing new around here it seems! Good luck and keep us posted! ' Mom Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 7, 2002 Report Share Posted February 7, 2002 I just heard from our pediatrician that Dane's DOC Band was denied by United Healthcare. Our policy doesn't cover orthotics, so we can't even appeal. What aggravates me is that I called 5 or 6 times and was told it would be covered with appropriate documentation. I spent $40 in courier fees. I wanted to have a receipt that someone actually signed for the documents and they couldn't say they were lost. The thing I feel the worst about is that I wasted the doctor's time. She did research and stayed until 10 or 11 one night writing this letter. My friend is an insurance agent and she said it seems that the job of the Customer Service Reps is just to get you off the phone. They have the disclaimer when you are on hold that says whatever is said in the conversation doesn't ensure coverage. Why am I calling if they are held to what they are saying? Why bother calling at all? Time to change insurance plans! We are still going through with the DOC Band. I don't care how much it costs. He shouldn't have to go through life with a lopsided face. Sorry for rambling. Dane's mom Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 7, 2002 Report Share Posted February 7, 2002 : What a bummer. I agree with everyone else's reply into looking into Durable Medical Equipment coverage. That's how my daughter's bands were covered - they covered 50% and we paid the other 1/2. Maybe look into it. That really is wrong for them to tell you they would cover it. Sorry Also, maybe search the archives with United Health Care as your search subject - I know I've heard UHC mentioned in here before. Debbie Abby's mom DOCgrad MI Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 8, 2002 Report Share Posted February 8, 2002 have I sent you these insurance links before? If not here they are this might help. We have UHC right now but for the life of me- my pregnancy marshmallow brain has kicked in and I. Cant remember who we had when we got the band because we moved since then. I will ask hubby and let you know if it was UHC then you can use us as an example. But UHC has been on the board many times before. OK here are some links.................... Good luck! Beck Click here: Insurance Issues Click here: State Insurance Departments Click here: Welcome to the Patient Advocate Foundation Click here: : Plagiocephaly Files Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 8, 2002 Report Share Posted February 8, 2002 Some UHC policies do cover orthotics, but ours doesn't. I actually did appeal it this morning. Our insurance agent said since the customer service reps told me it was covered and made me jump through hoops, that it might get approved. She has had luck 50% of the time in these situations. Since I only had to write a leter, I figure it was worth my time. I am crossing my fingers, but not holding my breath. We are still taking Dane for his casting tomorrow. Thanks for the info! > have I sent you these insurance links before? If not here they are > this might help. We have UHC right now but for the life of me- my pregnancy > marshmallow brain has kicked in and I. Cant remember who we had when we got > the band because we moved since then. I will ask hubby and let you know if it > was UHC then you can use us as an example. But UHC has been on the board many > times before. OK here are some links.................... > Good luck! > Beck > <A HREF= " http://www.plagiocephaly.org/support/insurance.htm " >Click here: Insurance Issues</A> > <A HREF= " http://www.plagiocephaly.org/support/SID.htm " >Click here: State Insurance Departments</A> > <A HREF= " http://www.patientadvocate.org/ " >Click here: Welcome to the Patient Advocate Foundation</A> > <A HREF= " Plagiocephaly/files/Help% 20Folder/ " >Click here: : Plagiocephaly Files</A> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 10, 2002 Report Share Posted February 10, 2002 sorry it took me so long to get back here..been a busy lady!! tucker is having a hard time sleeping and could possibly be teething again..caint tell for sure cause he wont open his mouth w/out bitting me with his other 6 teeth!!..anyways.... i wanted to adress this part by part..first of all, when i appealed, i sent the fda's statement saying it was not investigional. apparently they don't believe me!! second, i also sent the letter from the specialist saying that tucker did indead need the docband to prevent tmj problems and so forth...guess they don't believe me again!! again the 3 reasons they gave me was that the treatment is considered not medically necessary, its investigational and because there is no documented functional impairment..i would think the fda would prove the investigational wrong the dr note prove the other..what should i do...how do i find out where my local American Arbitration Association is since that is where they told me to appeal next.. thank you all brenda mom of tucker Re: DENIED Well, it looks like they have thrown everything in the book at you. Please check out our files section under insurance help. There is some very helpful information located there that might help you to figure out where to start. You can and should appeal. As far as the investigational part - the DOC clinic can certainly help with that. The DOCband is FDA approved and not considered investigational. Do you have a letter of medical necessity from your specialist or ped? If not you need to get one as soon as possible. Some drs will write them quickly for you, others will need a lot of reminding and some won't do it at all. A letter of medical necessity will help significantly. In the insurance help section you will find some successful letters of appeal. That is where I started when writing my appeal. Make sure you document like CRAZY. Keep a detailed phone log of everyone you talk to and keep copies of absolutely everything whether or not you think you will need it. You definitely have a chance to fight this. Try to break it down into parts and address each of the reasons for denial separately within the same letter. You can do it - it seems overwhelming now, but you can do it! Good luck and let me know if I can be of further assistance. Marci (Mom to )OklahomaFor more plagio info Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 10, 2002 Report Share Posted February 10, 2002 thank you so much. you and lauryn will also be in my prayers..sorry i caint help you either!! brenda mom of tucker Re: DENIED Dear , I am not sure what your situation is so I can't answer you to the best of my ability. But, I wanted to say hello. How are you otherwise? It sounds as if you have a lot going on. I am new here. I made my first post a few minutes ago. You and Tucker are in my prayers. God bless and nice to meet you! Sincerely, For more plagio info Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 10, 2002 Report Share Posted February 10, 2002 , Good luck with the appeal - I really hope it works out for you. Marci (mom to ) Oklahoma Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2002 Report Share Posted February 11, 2002 Dear , I am not sure what your situation is so I can't answer you to the best of my ability. But, I wanted to say hello. How are you otherwise? It sounds as if you have a lot going on. I am new here. I made my first post a few minutes ago. You and Tucker are in my prayers. God bless and nice to meet you! Sincerely, Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2002 Report Share Posted February 11, 2002 Dear , That is ok. I think we will just learn together. This is sooo confusing. I got a paper on Lauryn the other day in the mail and it has some mighty fancy medical terms in it. (sigh) Maybe someone else can help us in the morning. Talk to you soon. Sincerely, Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2002 Report Share Posted February 11, 2002 my insurance is alliance midwest security..they are out of onlaska wisonsin..that is also where i am..wi.... brenda mom of tucker RE: DENIED , You’ve probably mentioned this and I just can’t find it, but what insurance company are you dealing with? Thanks, (and )For more plagio info Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2002 Report Share Posted February 11, 2002 no tucker does not have tort ..he just has positional plagiocephaly.. Re: DENIED ,Does Tucker have tort? That would be a functional impairment. Also, can your neuro recommend a vision screening? If he could be screened for vision field neglect or something along those lines then that would be a functional impairment.I would suggest looking on line for the arbitration thing. I believe every state has one.Good luck and I'm so, so sorry that your insurance company is being so IGNORANT!!!!Marci (Mom to )OklahomaFor more plagio info Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2002 Report Share Posted February 11, 2002 , Does Tucker have tort? That would be a functional impairment. Also, can your neuro recommend a vision screening? If he could be screened for vision field neglect or something along those lines then that would be a functional impairment. I would suggest looking on line for the arbitration thing. I believe every state has one. Good luck and I'm so, so sorry that your insurance company is being so IGNORANT!!!! Marci (Mom to ) Oklahoma Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2002 Report Share Posted February 11, 2002 , You’ve probably mentioned this and I just can’t find it, but what insurance company are you dealing with? Thanks, (and ) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 1, 2008 Report Share Posted October 1, 2008 leigh wrote: Well I got the denial letter today. ~~~~~~~~~~~~~~~~ From who..? ~~~~~~~~~~~~~~~~ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 1, 2008 Report Share Posted October 1, 2008 I'm very sorry you were denied. I'm glad you got an attorney. I will keep you in my prayers, Tawny > > Well I got the denial letter today. Im so upset, feeling hopeless, > like there is no light at the end of my tunnel.I really think these > case analysts are souless,evil people, who get their kicks off > knocking people when theyre already down!I already contacted an > attorny though, Im not going down w/out a fight!! > > Wish me luck & pray for me please people.... > > randeelee > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 1, 2008 Report Share Posted October 1, 2008 Good luck! My thoughts and prayers are with you! I had to fight the system for five years! I was denied and got an attorney right away. I had panic disorder with my phsyical disabilities and couldn't leave my house to walk out the front door and was denied. I didn't even pass the medical exams they sent me on. It is an insane unfair system and I suggest to everyone now to get an attorney right when they need to file. Stay strong, I am sure it will turn out in your favor From: leigh <touch_4_health@...> Subject: [ ] Denied Date: Wednesday, October 1, 2008, 9:34 PM Well I got the denial letter today. Im so upset, feeling hopeless, like there is no light at the end of my tunnel.I really think these case analysts are souless,evil people, who get their kicks off knocking people when theyre already down!I already contacted an attorny though, Im not going down w/out a fight!! Wish me luck & pray for me please people.... randeelee Quote Link to comment Share on other sites More sharing options...
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