Guest guest Posted February 22, 2002 Report Share Posted February 22, 2002 Christi: This page will probably be of some help... www.plagiocephaly.org/support/insurance.htm Kendra Appeals Suggestions If anyone has any suggestions on appeals Id really appreciate it. I am about as blonde as blonde gets and have no idea what I am doing and could really use some help and suggestions. Thanks so much!ChristiFor more plagio info Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 22, 2002 Report Share Posted February 22, 2002 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 22, 2002 Report Share Posted February 22, 2002 Christi, If you could remind me what the reason for denial was I will try to help. Marci Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 23, 2002 Report Share Posted February 23, 2002 Well actually I am unsure. I have no received a written denial letter yet. My husband was denied in person and also I recieved a phone call of denial and the IG of the military hospital was also told of our denial. Two different things were told as reasons. One was that it was cosmetic. That was told to my husband but to me and to the IG we were told it was just not a covered benefit. So I am waiting for my denial letter to see exactly what it says. Thanks CHristi > Christi, > > If you could remind me what the reason for denial was I will try to help. > > Marci Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 23, 2002 Report Share Posted February 23, 2002 Beck thanks so much for the links!! Christi mom to Mya --- bbbhand@... wrote: > > 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 24, 2002 Report Share Posted February 24, 2002 Christi, Do you have any kind of written policy manual? If so, could you check to see if you have durable medical equipment coverage? If you do then the helmet WOULD be a covered benefit, however, there is usually a stipulation that it is only a covered benefit if it is medically necessary. You definitely need that written denial before completing an appeal. In the meanwhile you should try and obtain a letter of medical necessity from your specialist and start printing out as many articles as you can find about non-cosmetic issues that could arise from plagio to send in with your appeal. Good luck and keep us posted. Marci (Mom to ) Oklahoma Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 24, 2002 Report Share Posted February 24, 2002 Christi, Check out our files - I believe there are some appeals letters there that might help you to get started. I agree that getting started was one of the hardest parts. Is there anyone you can speak with and ask if durable medical equipment is covered? Sorry for all the strouble and stress. If you cannot find an appeals letter in the files section I would be more then happy to email my appeals letters (yes, I had to write several) to you for reference. They are in Microsoft Word format. Just let me know. Marci (mom to ) Oklahoma Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 24, 2002 Report Share Posted February 24, 2002 Hey Christi there are sample appeal letters in the files section try using one of them and some of their wording to get you started that might help. Here is the link. Beck Click here: : Plagiocephaly Files Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 24, 2002 Report Share Posted February 24, 2002 hey Marci- put your appeal letters in the files section:-) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2002 Report Share Posted February 25, 2002 Marci Nope this is the military we are talking about here. I was never given any kind of policy manual so I have no clue what is covered or not covered. And as for a letter of medical necessity. I have that letter from a cranialfacial specialist. I got that as soon as I found out we were denied. And I am also getting a letter from the doctor that referred me to the specialist the doctor that did the ct and sent mya to physical therapy for the torticollis. SHe is the first person to ever tell us about the DOC band. I am really worried about the appeals letter all of the ones I have seen look so professional. And I am far from professional. I am a 26 year old stay at home mom who hasnt worked in 8 years and when I did it was waitressing. I just dont even know where to begin with a letter and how to make it look so professional and look like I know what I am doing. Thanks for your help I will start printing out articles. Christi mom to MYa --- marcisch@... wrote: > Christi, > > Do you have any kind of written policy manual? If > so, could you check to see > if you have durable medical equipment coverage? If > you do then the helmet > WOULD be a covered benefit, however, there is > usually a stipulation that it > is only a covered benefit if it is medically > necessary. You definitely need > that written denial before completing an appeal. In > the meanwhile you should > try and obtain a letter of medical necessity from > your specialist and start > printing out as many articles as you can find about > non-cosmetic issues that > could arise from plagio to send in with your appeal. > > Good luck and keep us posted. > > Marci (Mom to ) > Oklahoma > __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2002 Report Share Posted February 25, 2002 Marci, I think I am going to call the Tricare office tommorrow and see if they will give me a book or something of covered benefits. I would assume they have to have some kind of record on what it covered and what is not. I would appreciate it greatly if you would send me a copy of your appeals letters as a reference. Thanks so much for your help. CHristi mom to MYA --- marcisch@... wrote: > Christi, > > Check out our files - I believe there are some > appeals letters there that > might help you to get started. I agree that getting > started was one of the > hardest parts. Is there anyone you can speak with > and ask if durable medical > equipment is covered? Sorry for all the strouble and > stress. If you cannot > find an appeals letter in the files section I would > be more then happy to > email my appeals letters (yes, I had to write > several) to you for reference. > They are in Microsoft Word format. Just let me know. > > Marci (mom to ) > Oklahoma > __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2002 Report Share Posted February 25, 2002 Christi, I just forwarded you the information you requested to your personal email address. Unfortunately it took me two tries because I forgot to actually attach the documents the first time - oops - sorry about that! Good luck and keep us posted. Marci Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2002 Report Share Posted February 25, 2002 Well, my appeal letters were not successful. I lost all of my appeals. What finally did the trick was when I had my case sent to an External Review Board. It was the members of the External Review Board that got my claim paid. I feel like they were darn good letters, but they don't officially qualify as " successful appeal letters " . Marci Quote Link to comment Share on other sites More sharing options...
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