Re: Time to appeal.....Principal Insurance! All help appreciated! (VERY LONG!!!!)

[Guest guest]

Hi

Sorry i have no solutions for your appeal i just wanted to wish you the very

best of luck and you stick with it. i thinks its totally disgusting that we

as parents are not told about plagiocephaly. We do need to spread the word

definatley. I just feel so bad for everyone when they say its for cosmetic

purposes only. If my son had not had the DOCband i was told he would have

been grossly deformed and that had i known about plagio it may have been

possible to have prevented it. I was given the brush off by pediatricians in

the UK saying the usual rubbish " it will round out in time " . I was lucky

that i got the help when i moved to Canada, i really feel for you guys apart

from having the worry of plagio in the first place but then to have to fight

the insurance companies - boy does it make my blood boil.

Like i said i wish you the very best of luck. Keep us posted to how the

fight is going.

Best wishes

Kerry

Calgary,AB

>From: andrea townsend <andreaoskarkat@...>

>Reply-Plagiocephaly

>Plagiocephaly

>Subject: Time to appeal.....Principal Insurance! All help

>appreciated! (VERY LONG!!!!)

>Date: Tue, 30 Apr 2002 16:24:42 -0700 (PDT)

>

>Hi!

>I first noticed my son to have plagiocephaly at 2

>months. I tried the repositioning techniques for 2

>months but the condition actually worsened. At 4

>months, my Pediatric PA referred me to a craniofacial

>surgeon who recommended a DOC Band as we had already

>been doing repositioning. (I am a Physician Assistant

>and had some articles on Plagiocephaly already).

>He was casted and in a band within 2 weeks. He

>remained in the band for around 2 and 1/2 months with

>wonderful improvement. We decided not to have another

>band put on as we were very happy with the results and

>so was the Craniofacial Surgeon.

>The

>Craniofacial Surgeon wrote a compelling letter of

>medical necessity.

>Still....despite all of my input as a Medical

>Professional, I recieved a denial.

>It was very short and basically all it said was that

> " The use of a cranial orthosis or remodeling band or

>helmet for the diagnosis of positional plagiocephaly

>is not considered to be medically necessary as it does

>not correct ot improve bodily function). As suchm no

>benefits are available under this plan.

>That was it!

>I had already sent documentation.

>I was told by Cranial Technologies in Atlanta that

>they had never recieved coverage by Principal.

>However, when I went for precertification, and I asked

>them what chance I had for coverage, they told me a

>50-50% chance.

>That was in January.

>Finally, in April, I recieved our denial letter as

>stated above.

>My questions are this....do I go after them and make

>them prove to me that they have ever paid for a

>band....and if so, why was my son's denied. Or...did

>they in fact never pay for a band, and in essence led

>me on with false hope?

>The other glitch is that I work for a hospital...in

>fact, the hospital I work for is the #1 Baby Hospital

>in the country i.e., they deliver more babies than

>any other hospital in the country...and they are BIG

>proponents of the BACK to SLEEP Campaign, but nowhere,

>in their " Home with Mom " brochures, do they ever warn

>of plagiocephaly as a possible outcome of the Back to

>Sleep Campaign....and our insurance company is

>Principal which doesn't cover their own employee's

>kids which I think would be an embarrassment to the

>administration if this were to be found out....

>I can't imagine that they know this!

>I put a lot into my original letter which most people

>probably wait to put in for their appeal...since I

>already had a lot of ammunition. They waited 3 months

>to deny me (apparently they usually deny within a

>couple of days)!

>Anyway, does anyone have any other info on how banding

>corrects bodily function????

>I do not plan to rest on my laurels on this one....

>what is the process here?

>What does a 1st appeal involve? What does a 2nd appeal

>involve? What is an external review? And then finally,

>when does one call in the lawyers?

>I promise that I plan to win this one.

>We already paid the $3000 as it was in our child's

>best interest to do this in the 4-6 month

>window....now, I plan to FIGHT!!!!

>All advice is appreciated!

>Thank you,

> L. Townsend

>

>

>__________________________________________________

>

[Guest guest]

Hi ,

I can totally relate with the insurance thing, I am in

a battle with my insurance company as well. They have

unofficially denied me twice with letters. My next

step is to appeal. I wish you the best of luck, I

will be praying for you

Helen and

--- andrea townsend <andreaoskarkat@...> wrote:

> Hi!

> I first noticed my son to have plagiocephaly at 2

> months. I tried the repositioning techniques for 2

> months but the condition actually worsened. At 4

> months, my Pediatric PA referred me to a

> craniofacial

> surgeon who recommended a DOC Band as we had already

> been doing repositioning. (I am a Physician

> Assistant

> and had some articles on Plagiocephaly already).

> He was casted and in a band within 2 weeks. He

> remained in the band for around 2 and 1/2 months

> with

> wonderful improvement. We decided not to have

> another

> band put on as we were very happy with the results

> and

> so was the Craniofacial Surgeon.

> The

> Craniofacial Surgeon wrote a compelling letter of

> medical necessity.

> Still....despite all of my input as a Medical

> Professional, I recieved a denial.

> It was very short and basically all it said was that

> " The use of a cranial orthosis or remodeling band or

> helmet for the diagnosis of positional plagiocephaly

> is not considered to be medically necessary as it

> does

> not correct ot improve bodily function). As suchm no

> benefits are available under this plan.

> That was it!

> I had already sent documentation.

> I was told by Cranial Technologies in Atlanta that

> they had never recieved coverage by Principal.

> However, when I went for precertification, and I

> asked

> them what chance I had for coverage, they told me a

> 50-50% chance.

> That was in January.

> Finally, in April, I recieved our denial letter as

> stated above.

> My questions are this....do I go after them and make

> them prove to me that they have ever paid for a

> band....and if so, why was my son's denied. Or...did

> they in fact never pay for a band, and in essence

> led

> me on with false hope?

> The other glitch is that I work for a hospital...in

> fact, the hospital I work for is the #1 Baby

> Hospital

> in the country i.e., they deliver more babies than

> any other hospital in the country...and they are

> BIG

> proponents of the BACK to SLEEP Campaign, but

> nowhere,

> in their " Home with Mom " brochures, do they ever

> warn

> of plagiocephaly as a possible outcome of the Back

> to

> Sleep Campaign....and our insurance company is

> Principal which doesn't cover their own employee's

> kids which I think would be an embarrassment to the

> administration if this were to be found out....

> I can't imagine that they know this!

> I put a lot into my original letter which most

> people

> probably wait to put in for their appeal...since I

> already had a lot of ammunition. They waited 3

> months

> to deny me (apparently they usually deny within a

> couple of days)!

> Anyway, does anyone have any other info on how

> banding

> corrects bodily function????

> I do not plan to rest on my laurels on this one....

> what is the process here?

> What does a 1st appeal involve? What does a 2nd

> appeal

> involve? What is an external review? And then

> finally,

> when does one call in the lawyers?

> I promise that I plan to win this one.

> We already paid the $3000 as it was in our child's

> best interest to do this in the 4-6 month

> window....now, I plan to FIGHT!!!!

> All advice is appreciated!

> Thank you,

> L. Townsend

>

>

> __________________________________________________

>