Re: United Healtcare first submission

[Guest guest]

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Geez! There are a few of us here dealing with UHC now! has

her face to face appeal this afternoon.

I don't want to freak you out, but here in Ohio you need

precertification for any DME over $1k. When I originally

called " customer service " I was told I didn't need precert. I

called back an hour later to double check with someone else who told

me I did. I get a different answer everytime I call.

For my precert I sent in a letter from the ped and the info from CT

with the measurements. There are 3 of us in Cleveland (so far) who

were denied by UHC because our policies don't cover orthotics. I

didn't realize that the DOC Band wasn't an orthotic until

told me.

Although I hope you don't have to, be prepared for a fight. If you

read my ealier posts you can see that I am on a mission to make this

easier for parents in the future to get their insurance to pay.

UHC denied $21k in Dane's NICU bills because of one teeny weeny

loophole. I don't have much respect for them.

Fight the power!

Dane's mom

> > > Ana -

> > > Any news on your appeal with UHC?

> > >

> > > Dane's mom (DOC Band 2/14)

[Guest guest]

Hi ,

We didn't have to submit anything oursleves. Cranial Technologies

(where we got our DOC band) has filed all the insurance paperwork

for us. I called CT and asked what you should include. Here's what

they said:

A letter of medical necessity

A prescription from the doctor for the device

Include the estimated length of treatment

A Procedure Code

A Diagnosis Code

They said UHC will ask for all that information, so if you send it

to them first, it might cut back on the decision making time. They

said you should be able to get a diagnosis and procedure code from

the doctor or treatment center.

Hope that helps! Let me know if you have other questions> I can call

CT and ask.

Ana ~Jace's Mom (Banded 4/5/02)

> > > Ana -

> > > Any news on your appeal with UHC?

> > >

> > > Dane's mom (DOC Band 2/14)

[Guest guest]

> > > Ana -

> > > Any news on your appeal with UHC?

> > >

> > > Dane's mom (DOC Band 2/14)

[Guest guest]

To add to the precert issue. CT called BeechStreet PPO to get a

precert for UHC and were told they didn't need one. Well UHC said

they did. After 2 weeks of waiting, I called BS and UHC myself.

Beechstreet said no precert was needed and I talked to someone at

UHC through my employee hotline that said it wasn't needed. SO

is right, different answers from everyone. We finally said

screw it and went ahead with casting. Time's wasting!! CT was able

to get a preauthorization (which, from what I understand is

different from a precert) and UHC said they covered 80%. BUT that

does not mean that they will cover it. It just means that should

they decide to cover it, 80% is what they will cover. BASTARDS!!!

count me in on a lawsuit! I'm ready to fight too! You know

what they say....Don't mess with Texas. Well that includes Mom's in

Texas whose cute little children have plagio and tort and their

freakin insurance providers, who take their money, will not pay to

cover bands and helmets and PT!!!CREEPS! Whew!

Ana ~ Jace's Mom (DOC band 4-5-02)

> > > > Ana -

> > > > Any news on your appeal with UHC?

> > > >

> > > > Dane's mom (DOC Band 2/14)

[Guest guest]

Ana,

Thanks so much for going to all that trouble to call CT. It's great

that the submit all of the paperwork for you.

Unfortunately, the place we go to refuses to deal with any insurance

companies (probably because of refusals to pay, I imagine!), and they

basically have a lock on the helmet market in NYC from what I

understand. The office folks at the ortho center who have been

'helping' me with the paperwork don't seem to have much of a clue

about what to submit, and I am reluctant to ask UHC for obvious

reasons. We are going to have to assemble the required info and just

try it and see what they say.

Good luck to all!

> > > > Ana -

> > > > Any news on your appeal with UHC?

> > > >

> > > > Dane's mom (DOC Band 2/14)

[Guest guest]

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How close are you to CT in Paramus, NJ? If it's not too far it

might be worth the drive for you.

Dane's mom

> > > > > Ana -

> > > > > Any news on your appeal with UHC?

> > > > >

> > > > > Dane's mom (DOC Band 2/14)