Guest guest Posted February 23, 2002 Report Share Posted February 23, 2002 : I am more than happy to fax them information with the proof that the DOCband works! What a crock. They're grabbing at straws now finding any way possible to deny your claim. How sad. I'll also fax them Abby's before & after photos which show how much her head improved in her DOCband. I'll fax them this weekend yet! grrrr, insurance companies have a way of riling me up! Debbie Abby's mom DOCgrad MI > Hello. > > As you all know, I am still fighting with my insurance company about 's DOC Band. I received a letter yesterday from Reiners, MD the medical director at Anthem Blue Coss and Blue Shield. In short, the letter states, eventhough FDA approved, that Anthem requires a thorough assurance that Dynamic Orthotic Cranioplasty has been shown effective in the treatment of plagiocephaly without synostosis through evidence found in medical literature. The letter admits that further reserach needs to be done to see the outcome of plagiocephaly. It also states that the DOC Band has not been part of well-controlled comparisons with other devices and untreated plagiocephaly and repositioning techniques. The device will only be covered if it has shown proven effectiveness. > > The criteria for Experimental/Investigational: > > 1.) The scientific evidence does not permit conclusions concerning the effect of the Service on health outcomes; or > 2.) the service does not improve net health outcome by producing beneficiial effects that outweigt any harmful effects;or > 3.) The service has not shown to be beneficial as any of the established alternate services with evidence demonstrating that the service improves net health outcomes as much as, or more than, established altenatives; or > 4.) The service has not been shown to improve net health outcomes under the usual conditions of medical practice outside investigatory settings. > > > Sorry for the complexity of this letter. I was wondering if anyone has information that can dispute any of the criteria for investigational/experimental. Also, I was wondering if anyone/everyone could write a letter telling how the DOC Band has worked/effective for your child/childern and any other information that would be of great help with 's DOC Band Appeal.. I am so desperate at this point for anything. However, since this is such short notice, appeal hearing is Feb 27, at 11:30, I need the above information faxed . > > Fax Information: > > Cheryl Jordan > Level 2 Appeal > Anthem Blue Cross and Blue Shield > 317-287-5968 (Fax number) > > Just write: I,name here, and submitting evidence/story, in relation to s appeal for Dynamic Orthotic Cranioplasty, by request of his mother, s,........story/evidence. > > Or just anyway you seem fitting, just be sure to include s and DOC Band in your letter. > > Thank you for any and all of your help so far. > > s Quote Link to comment Share on other sites More sharing options...
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