Guest guest Posted April 17, 2002 Report Share Posted April 17, 2002 Oh how terrible that is!! I can not beleive that!! WEll you have the fax confirmation sheet cant you use that to make them give you the face to face appeal. SInce it confirms the fax was received? Oh that just bugs me so much. I am already all fired up about Tricare. I just dont get these insurance companies! They are making decisions on what should be covered and what shouldnt be when they have no idea what the medical need is. They dont have medical degrees to even understand and they probably dont even care to find out what the medical necessity is. Ughhhh I am so angered! Keep fighting!! Make them pay!!!!! Christi mom to Mya -- In Plagiocephaly@y..., " rmanias " <rmanias@a...> wrote: > OK - Can you see the steam coming out of my ears? UHC is claiming > they never received my request for a face to face appeal and it is > now too late to request one. There was a fax confirmation sheet. I > am quite enraged. I asked the woman if never received means it was > thrown in the trash. As you can imagine I am not the happiest > person right now. I need a Vicadan or something! UGH! They will > pay. I am already in teh process of dragging this into the public > arena. God knows no fury as a woman scorned! > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 17, 2002 Report Share Posted April 17, 2002 Cristi- I sent my bro an email. He is on congressional staff and always is working with veterans and soldiers about their benefits. He should be able to point you in the right directions. As far as I'm concerned, anyone child whose parent is in the military deserves a gold plated DOC Band (with a/c for the summer of course!). Dane's mom > > OK - Can you see the steam coming out of my ears? UHC is claiming > > they never received my request for a face to face appeal and it is > > now too late to request one. There was a fax confirmation sheet. > I > > am quite enraged. I asked the woman if never received means it was > > thrown in the trash. As you can imagine I am not the happiest > > person right now. I need a Vicadan or something! UGH! They will > > pay. I am already in teh process of dragging this into the public > > arena. God knows no fury as a woman scorned! > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 17, 2002 Report Share Posted April 17, 2002 Oh boy YIKES! Gotta love the mysteriously " lost " or " never rec'd " insurance paperwork. What a joke! So now what are you/they going to do? I don't think they should be getting on your bad side!! Debbie Abby's mom DOCGrad MI > OK - Can you see the steam coming out of my ears? UHC is claiming > they never received my request for a face to face appeal and it is > now too late to request one. There was a fax confirmation sheet. I > am quite enraged. I asked the woman if never received means it was > thrown in the trash. As you can imagine I am not the happiest > person right now. I need a Vicadan or something! UGH! They will > pay. I am already in teh process of dragging this into the public > arena. God knows no fury as a woman scorned! > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 18, 2002 Report Share Posted April 18, 2002 Oh man , gotta love these insurance companies. I am so ticked off for you that UHC is giving you the run around. Do you still have the fax confirmation sheet to prove that you requested a face to face appeal? Be sure to document all these conversations, more ammo for your appeals. Good luck ! Niki Kaylie & Danny (STAR grads) Phila., PA > OK - Can you see the steam coming out of my ears? UHC is claiming > they never received my request for a face to face appeal and it is > now too late to request one. There was a fax confirmation sheet. I > am quite enraged. I asked the woman if never received means it was > thrown in the trash. As you can imagine I am not the happiest > person right now. I need a Vicadan or something! UGH! They will > pay. I am already in teh process of dragging this into the public > arena. God knows no fury as a woman scorned! > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 5, 2007 Report Share Posted November 5, 2007 I don't think my policy included that statement but I'd be happy to send you a copy of my succesful appeal if you post your email. > > Has anyone been successful with a UHC appeal for the DOC band, where > the policy states " Orthotic appliances that straighten or re-shape a > body part (including some type of braces) are excluded? " I'm trying to > write our appeal, and I would love any advice or tips with those of you > who have been successful. Our son Payton has severe plagiocephaly on > his left side, and we have tried for months with repositioning. He has > favored his left side while sleeping since birth, but we didn't really > notice a flat spot until he was a few months old. He's in the DOC band > now, and everything is going wonderful. We're just struggling > financially and need the insurance company to help us out, especially > since Payton's case was severe. > > Thanks so much for your help! > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 6, 2007 Report Share Posted November 6, 2007 I would love a copy as well, I am princessluau@.... Thanks Tammylka_236 <lka_236@...> wrote: I don't think my policy included that statement but I'd be happy to send you a copy of my succesful appeal if you post your email.>> Has anyone been successful with a UHC appeal for the DOC band, where > the policy states "Orthotic appliances that straighten or re-shape a > body part (including some type of braces) are excluded?" I'm trying to > write our appeal, and I would love any advice or tips with those of you > who have been successful. Our son Payton has severe plagiocephaly on > his left side, and we have tried for months with repositioning. He has > favored his left side while sleeping since birth, but we didn't really > notice a flat spot until he was a few months old. He's in the DOC band > now, and everything is going wonderful. We're just struggling > financially and need the insurance company to help us out, especially > since Payton's case was severe. > > Thanks so much for your help! > __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 6, 2007 Report Share Posted November 6, 2007 I also need help with the UHC appeal process due to an exclusion in our policy. I spoke with someone at Cranial Tech today and they said that some people overturn the appeal due to a loophole they use in United Healthcare's wording. Does anyone know anything about this loophole??? Lauri My e-mail is Lck71@... > > > > Has anyone been successful with a UHC appeal for the DOC band, > where > > the policy states " Orthotic appliances that straighten or re- shape > a > > body part (including some type of braces) are excluded? " I'm > trying to > > write our appeal, and I would love any advice or tips with those > of you > > who have been successful. Our son Payton has severe plagiocephaly > on > > his left side, and we have tried for months with repositioning. > He has > > favored his left side while sleeping since birth, but we didn't > really > > notice a flat spot until he was a few months old. He's in the DOC > band > > now, and everything is going wonderful. We're just struggling > > financially and need the insurance company to help us out, > especially > > since Payton's case was severe. > > > > Thanks so much for your help! > > > > > > > > > __________________________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 6, 2007 Report Share Posted November 6, 2007 Keri, I've copied and pasted a " generic email " that I've sent to many people that are battling UHC. The process was not that hard....we went to CT, got script from Ped., got doctor to write letter of medical necessity, we sent our paperwork to UHC including the claim (after recieving the denial letter) and they sent CT a reimbursement check (since we had already paid for the band...CT cut us a check and that was it). Let me know if you have other questions. My email is lka_236@... Hi, We won our UHC appeal (1st attempt) and were reimbursed 80% (which is what we expected from our policy). It is important to use wording from your specific policy because UHC can't deny what your policy says! I joined the plagio group to gain access to their insurance help links. My letter is a combination of the letters on that site but changed to work for us. You can get your policy from whomever your policy is through. For example, we get UHC through my husband's work so he went to his HR department to request our policy. UHC won't have it as every company recieves different benefits. Good luck and let me know if you have any questions. PS: I sent UHC the letter, a letter of medical necessity, CT's medical records (they saw my son at 3 months and 6.5 months...they mentioned in their notes that we had attempted repositioning but weren't satisfied with the results and that banding would still benefit my son). I can't remember what else I included but after my signature you'll see " enclosures " which will tell you what all I included. PS: CT has an insurance appeals packet that I found to be helpful too. > > > > > > Has anyone been successful with a UHC appeal for the DOC band, > > where > > > the policy states " Orthotic appliances that straighten or re- > shape > > a > > > body part (including some type of braces) are excluded? " I'm > > trying to > > > write our appeal, and I would love any advice or tips with those > > of you > > > who have been successful. Our son Payton has severe > plagiocephaly > > on > > > his left side, and we have tried for months with repositioning. > > He has > > > favored his left side while sleeping since birth, but we didn't > > really > > > notice a flat spot until he was a few months old. He's in the > DOC > > band > > > now, and everything is going wonderful. We're just struggling > > > financially and need the insurance company to help us out, > > especially > > > since Payton's case was severe. > > > > > > Thanks so much for your help! > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 6, 2007 Report Share Posted November 6, 2007 Nikki, I just sent a copy of my appeal. Let me know if you don't get it. > > > > > > Has anyone been successful with a UHC appeal for the DOC band, > > where > > > the policy states " Orthotic appliances that straighten or re- > shape > > a > > > body part (including some type of braces) are excluded? " I'm > > trying to > > > write our appeal, and I would love any advice or tips with those > > of you > > > who have been successful. Our son Payton has severe > plagiocephaly > > on > > > his left side, and we have tried for months with repositioning. > > He has > > > favored his left side while sleeping since birth, but we didn't > > really > > > notice a flat spot until he was a few months old. He's in the > DOC > > band > > > now, and everything is going wonderful. We're just struggling > > > financially and need the insurance company to help us out, > > especially > > > since Payton's case was severe. > > > > > > Thanks so much for your help! > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 6, 2007 Report Share Posted November 6, 2007 Lauri, I just sent a copy of my appeal. Let me know if you don't get it. Unfortunately, I don't know anything about the loophole. > > > > > > Has anyone been successful with a UHC appeal for the DOC band, > > where > > > the policy states " Orthotic appliances that straighten or re- > shape > > a > > > body part (including some type of braces) are excluded? " I'm > > trying to > > > write our appeal, and I would love any advice or tips with those > > of you > > > who have been successful. Our son Payton has severe > plagiocephaly > > on > > > his left side, and we have tried for months with repositioning. > > He has > > > favored his left side while sleeping since birth, but we didn't > > really > > > notice a flat spot until he was a few months old. He's in the > DOC > > band > > > now, and everything is going wonderful. We're just struggling > > > financially and need the insurance company to help us out, > > especially > > > since Payton's case was severe. > > > > > > Thanks so much for your help! > > > > > > > > > > > > > > > > > __________________________________________________ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 7, 2007 Report Share Posted November 7, 2007 - I didn't receive a copy of your appeal - thank you so much for sending me that!!! Can you send it to Lck71@... Thank you so much! Lauri Re: UHC Appeal Lauri,I just sent a copy of my appeal. Let me know if you don't get it. Unfortunately, I don't know anything about the loophole.> > >> > > Has anyone been successful with a UHC appeal for the DOC band, > > where > > > the policy states "Orthotic appliances that straighten or re-> shape > > a > > > body part (including some type of braces) are excluded?" I'm > > trying to > > > write our appeal, and I would love any advice or tips with those > > of you > > > who have been successful. Our son Payton has severe > plagiocephaly > > on > > > his left side, and we have tried for months with repositioning. > > He has > > > favored his left side while sleeping since birth, but we didn't > > really > > > notice a flat spot until he was a few months old. He's in the > DOC > > band > > > now, and everything is going wonderful. We're just struggling > > > financially and need the insurance company to help us out, > > especially > > > since Payton's case was severe. > > > > > > Thanks so much for your help! > > >> > > > > > > > > > > > > > ____________ _________ _________ _________ _________ __> > Quote Link to comment Share on other sites More sharing options...
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