Re: I received my denial letter from Cigna

[Guest guest]

Hi ,

I am going through some of the same things you are

with my insurance. My insurance company says I need a

letter of medical necessity from both my pt and

primary care physican. The company that made my

daughter's helmet is also sending a packet of

information about the helmet telling how it works and

why they feel it is helpful in treating positional

plagiocephaly. Also, the American Medical Association

says that a cosmetic procedure changes normal

structure of the body in order to improve appearance.

A reconstructive procedure, on the other hand, is

performed on an abnormal structure of the body to

improve function, or return to normal. Also, when

researching plagiocephaly on the Web many sites also

talked about problems that could arise later if

plagiocephaly was not addresses. These problems

included chewing and eating, vision and TMJ. Didn't

mean to get so technical, but I found this information

to be helpful to myself when wondering if this problem

was cosmetic. My daughter's plagio is moderate and we

were wondering if it could cause problems later in

life. Our physical therapist also confirmed this

information. I hope this helped. Good luck with the

appeal. Please let us know how it is going.

Helen and

--- gabbysmom85024 <dlicano@...> wrote:

> the reasons for the denial are..clinical information

> does not

> document a functional abnormality & does not

> document a trial of

> conservative medical therapy.Under the terms of your

> medical

> plan,cosmetic surgery or therapy is not a covered

> benefit.

> Ok so by conservative medical therapy do they mean

> repositioning? My

> daughter la was born with plagio due to

> having her brother sit

> on top of her for 9 months in the womb!! She is

> almost 10 months now

> and her head still looks the same way it did when

> she was born. She

> sleeps on both back and tummy and does not spend any

> time in a swing

> and very little time in car seat. I did take her to

> PT for her Tort

> and was just given instructions on excersises to do

> with her to

> strengthen her neck. Cigna, by the way, denied that

> too saying I

> needed to be referred. I was by my normal ped. and

> an OT. Cigna said

> someone didn't put in the right information then and

> PT will have to

> eat the fees. Should I include all of this in my

> appeal. Also,cigna

> covers durable medical devices that are medically

> necessary but not

> ones that are custom made for the individual, so

> should I say that it

> is medically necessary and send a letter from

> doctor confirming that

> (which they already have been sent) or will it hurt

> me to bring up

> durable medical devices since cigna states it

> excludes custom made

> ones? I know all my questions must sound stupid but

> I want to get

> everything right in my first appeal.So much time has

> already been

> wasted..Thank you anyone for your help!!!!!!!! ~

>

>

__________________________________________________

[Guest guest]

,

Too bad about the denial from Cigna. Glad to hear that you are appealing.

Yes, they probably are referring to repositioning. If you have already tried

that see if your dr will write a letter stating that repositioning has been

tried with little to no success. Then you will need a letter of medical

necessity. Since your baby had the plagio and tort before birth you should

have a good chance of winning an appeal. Just keep plugging away and don't

give up!

Good luck!

Marci (Mom to )

Oklahoma

[Guest guest]

---

Thanks Marci..We never really did try repositioning because gabriella

does not lay in the same position when I lay her down.So she

repositions herself i guess LOL. I will continue fighting.So glad to

find this site for support!!~

In Plagiocephaly@y..., marcisch@a... wrote:

> ,

>

> Too bad about the denial from Cigna. Glad to hear that you are

appealing.

> Yes, they probably are referring to repositioning. If you have

already tried

> that see if your dr will write a letter stating that repositioning

has been

> tried with little to no success. Then you will need a letter of

medical

> necessity. Since your baby had the plagio and tort before birth you

should

> have a good chance of winning an appeal. Just keep plugging away

and don't

> give up!

>

> Good luck!

>

> Marci (Mom to )

> Oklahoma