M-care insurance is a nightmare!!!!!

[Guest guest]

Hello,

Anyone out there ever have to deal with M-care? I

have been sent two denial letters for the helmet my

daughter has been wearing for a month now. I was told

that the company who was making my daughter's helmet

would not make it until they received an approval from

my insurance company. Ten days after my daughter was

casted she was fitted for her helmet. When they told

me to come and get the helmet I didn't even think

about asking if the insurance approved it because of

what I was told earlier. One week after my daughter

was in her helmet, I got the first denial letter. I

had my ped., phy. therapist, and the company who made

the helmet send in letters of medical necessity, only

to be denied a second time. I guess the only thing

left to do is to appeal. I also found out that the

helmet my daughter has has two different product

numbers and description. One description is saying

the helmet is being used for protective reasons after

cranial surgery and the other description is saying

that is a cranial molding helmet used to treat

postional plagiocephaly. The insurance is denying the

helmet because they say they do not cover " protective

helmets " . My daugther has postional plagiocephaly and

is not wearing this helme for protective reasons

(although, this is sometimes a bonus!!) Any

suggestions from anyone one out there?

Helen and

__________________________________________________

[Guest guest]

Helen:

You definitely have good reason to appeal, like you said, 's

helmet is NOT for protective reasons. They have something messed up

on their end. Give them a call or send them your appeal stating

exactly, word for word, that 's helmet is to treat positional

plagio.. Do you know if your ins. covers orthotic devices? My ins.

covered Abby's band as " durable medical equipment " covering 50% of

the cost. You also might want to check into that. 50% is better

than nothing!

How is doing in her helmet?

Debbie Abby's mom DOCgrad

MI

> Hello,

> Anyone out there ever have to deal with M-care? I

> have been sent two denial letters for the helmet my

> daughter has been wearing for a month now. I was told

> that the company who was making my daughter's helmet

> would not make it until they received an approval from

> my insurance company. Ten days after my daughter was

> casted she was fitted for her helmet. When they told

> me to come and get the helmet I didn't even think

> about asking if the insurance approved it because of

> what I was told earlier. One week after my daughter

> was in her helmet, I got the first denial letter. I

> had my ped., phy. therapist, and the company who made

> the helmet send in letters of medical necessity, only

> to be denied a second time. I guess the only thing

> left to do is to appeal. I also found out that the

> helmet my daughter has has two different product

> numbers and description. One description is saying

> the helmet is being used for protective reasons after

> cranial surgery and the other description is saying

> that is a cranial molding helmet used to treat

> postional plagiocephaly. The insurance is denying the

> helmet because they say they do not cover " protective

> helmets " . My daugther has postional plagiocephaly and

> is not wearing this helme for protective reasons

> (although, this is sometimes a bonus!!) Any

> suggestions from anyone one out there?

>

> Helen and

>

> __________________________________________________

>