Guest guest Posted March 22, 2002 Report Share Posted March 22, 2002 United healthcare covered ours 100% under durable medical equipment (DME). If your DME covered then fight them because its covered. Lorraine.In FL. Mom to Madison & Mackenzie(Doc grad). > Greeting Group! > United Healthcare has denied our claim. I have already written my > appeal but am doing and amendum to it. Has anyone successfully won > against UHC? > > The reason they are stating is: > " ORTHOTIC DEVISES (inculding shoe inserts) are not covered " . > As if my daughters helmet is a shoe device! the nerve!! > > Thanks, and Jane Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2002 Report Share Posted March 22, 2002 - We really have to get together! UHC has denied us twice for the same reason. We are waiting for a external review. Our insurance agent wants us to appeal on the basis that I was misled. I called them literally 8 times and was told it was covered. We jumped through all those hoops for no reason! The agent says we have a chance, so we are proceeding. The denial letter states that we should always call Customer Service to see if something is covered. DUH! I did that! Dane's mom Cleveland Hts Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2002 Report Share Posted March 22, 2002 Lorraine, Thank you! Yes it does say DME is covered..but they are telling my that the DOC is excluded because it is an Orthotic appliance (Go figure)? They are SCUM! DID they initially deny you and they appealed? Thanks, > > Greeting Group! > > United Healthcare has denied our claim. I have already written my > > appeal but am doing and amendum to it. Has anyone successfully won > > against UHC? > > > > The reason they are stating is: > > " ORTHOTIC DEVISES (inculding shoe inserts) are not covered " . > > As if my daughters helmet is a shoe device! the nerve!! > > > > Thanks, and Jane Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 2002 Report Share Posted March 23, 2002 , Awhile back we had another member asking something very similar to what you are asking now. Dulcey Lima, one of the professionals from Orthomerica (the makers of the STARband) gave this useful info: Some insurance policies exclude " orthotics " from coverage, but this term usually applies to the exclusion of FOOT ORTHOTICS. As an orthotist, I can tell you that many people have received denial letters for other type of orthotic devices because some insurance claims adjuster has selectively misinterpreted the word orthotic. Check your policy and find out if you have coverage for Durable Medical Equipment (DME). If you do, resubmit the claim with an explanation that this item is not a foot orthotic. Send a picture, and all your other documentation including a letter of medical necessity from your physician. Best of luck to you, Dulcey Lima C.O. Orthomerica Products, Inc. Try to get that letter of medical necessity, it will help you with your insurance appeal. Good luck , and be sure to keep us up to date! Niki Kaylie & Danny (STAR grads) Phila., PA > Greeting Group! > United Healthcare has denied our claim. I have already written my > appeal but am doing and amendum to it. Has anyone successfully won > against UHC? > > The reason they are stating is: > " ORTHOTIC DEVISES (inculding shoe inserts) are not covered " . > As if my daughters helmet is a shoe device! the nerve!! > > Thanks, and Jane Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 24, 2002 Report Share Posted March 24, 2002 Tricare has also denied us saying that orthotics including shoe inserts are an exclusion to our policy and right after it says the thing about shoe inserts it say DOC dynamic orthotic cranioplasty band are an exclusion . Its written out just like that. The copy I have is a faxed copy and I swear somebody quickly typed that in there and then faxed it. I am going to have to check into the durable medical equipment thing but theyll probably just type and exclusion in on that one too. Ughh so frustrating > > Greeting Group! > > United Healthcare has denied our claim. I have already written my > > appeal but am doing and amendum to it. Has anyone successfully won > > against UHC? > > > > The reason they are stating is: > > " ORTHOTIC DEVISES (inculding shoe inserts) are not covered " . > > As if my daughters helmet is a shoe device! the nerve!! > > > > Thanks, and Jane Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 24, 2002 Report Share Posted March 24, 2002 IMPORTANT TO KNOW..... Regarding TRICARE..You mentioned they specifically excluded DOC babds so it will be tougher to appeal. However, in the FAXED copy they sent you mentioned it looked like someone " quickly typed it on the form " .. Insurance Companies CANNOT make any changes/alterations to their forms (coverage and exclusion sections) unless they first submit it to the state for approval.. a process that takes MONTHS! Even if the change is approved by the state..it cannot be retrocactive meaning the change can only apply to policies going forward..and not those in existence (until the ones in existance renew into the new revision) So..be sure to check that exclusion to your home copy of certificate of coverage (if you have it) to verify that the language is the same. If you do not have a copy, ask for another copy from your HR dept, state Department of Insurance or insurance company. BE sure it has the FORM NUMBER (usually it is on the bottom of the page) INSURANCE COMPANIES ARE SO SNEAKY! GOOD LUCK! LESLIE > > > Greeting Group! > > > United Healthcare has denied our claim. I have already written > my > > > appeal but am doing and amendum to it. Has anyone successfully > won > > > against UHC? > > > > > > The reason they are stating is: > > > " ORTHOTIC DEVISES (inculding shoe inserts) are not covered " . > > > As if my daughters helmet is a shoe device! the nerve!! > > > > > > Thanks, and Jane Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 25, 2002 Report Share Posted March 25, 2002 In a message dated 3/22/02 9:53:31 AM Central Standard Time, userlko@... writes: << Yes it does say DME is covered >> Then the band should be covered! If you are using a DOCband maybe the CT clinic can help with documentation proving that the band is DME. Marci Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 25, 2006 Report Share Posted January 25, 2006 > greetings to all > I am going to a " specialist " refered by my endo what kind of > specialist could he be and now some one from his office called me and > said if you are going to see him about fertilty issues your insurance > does not cover it or have him coded other than that she adviced me. > My quesition for so many reasons ppl become like they we are and then > why is it when it comes to fertility or sexual issues insurace do not > cover it? Insurance does its best to not cover anything! I know thats not " quite " correct but they are fine if your using .02 cent bloodpressure meds but the cost of Hormones is pretty wild. Mine are around $1400.00 for 90 days worth and they really don't like paying out funds for non life and death stuff. Now, of course my life without them sucks big time. > So please if I am not asking to much please some assertive person help > me here to how I should approch the Doctor thanks any suggestions > wellcome. I want HCG like many ppl here are happy with their TRT > treatment here. thanks in advance.Jack I'm not on HCG but I would bring supporting data on why you think this is good meds for you. My Doctor was not tuned into the latest and greatest on this so I showed her the ACCE guidlines and believe it or not she read them and changed her mind on a few things. I hope you get a good doctor that doesn't just " think " they know eveything! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 26, 2006 Report Share Posted January 26, 2006 Well, what is your issue? Low testosterone, I presume. Hve you doctor use the ICD-9 code for " Hypogonadism " Check this web page, it gives the codes and some history of the disease: http://en.wikipedia.org/wiki/Gonadotropin_deficiency > Insurance issue > > greetings to all > I am going to a " specialist " refered by my endo what kind of >specialist could he be and now some one from his office called >me and said if you are going to see him about fertilty issues >your insurance does not cover it or have him coded other than >that she adviced me. >My quesition for so many reasons ppl become like they we are >and then why is it when it comes to fertility or sexual issues >insurace do not cover it? > >So please if I am not asking to much please some assertive >person help me here to how I should approch the Doctor thanks >any suggestions wellcome. I want HCG like many ppl here are >happy with their TRT treatment here. thanks in advance.Jack > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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