Re: dumb insurance question

[Guest guest]

You want to be able to quote the specific reason from your denial letter and find research and other helps to fight the specific reason for denial. I would wait until you get your actual letter before I sent in the appeal. In the mean time I would be finding articles/research, gathering all the copies of doctors letters, pictures of the baby's head from lots of different views, CT films and anything else you think may help your fight. Be sure to send a copy of any and all letters you get from the insurance company and any PT or doctors. Don't assume they have copies of anything. I sent pictures of Ethan at 3 months and some when he was 6 months to show the appeals board that we had been doing repositionong exercises, but there had been little to no change. Remeber, a pictureis worth a thousand words.I am currently waiting to hear back from Cigna on our first appeal. Look on this web site, the CAPPS kids web site and the Cranial Tech. site for great articles and researcg helps. There are also a lot of sample appeals letters to help get you started. Good Luck.

and Ethan

Gilbert, AZ

gradh <gradh@...> wrote: This is probably a dumb question but here goes...before I can write anappeal to CCN for denying the DOCband for Mackenzie, do I have to waitfor the denial letter itself? We know it was denied because CT got thecall and received the verbal denial. However, most of the sample appealletters I've seen in the help section here all reference a denial letteritself. Are we spinning our wheels again until we receive the actualwritten denial? Boy, do I hope that all of that made sense...if anybody could help me,I'd really appreciate it. & MackenziePhoenix, AZFor more plagio info

[Guest guest]

,

You need the written denial - call your insurance and ask if it has been sent

and if it hasn't then tell them to get on with it because you intend to file

an appeal immediately. You might also ask them to include the guidelines for

appeals with the denial letter. You need the denial letter so you can very

specifically address their basis for denial in your appeal.

Marci (Mom to )

Oklahoma

[Guest guest]

,

That's not a dumb question at all! I thought the same thing, but writing our appeal letter made so much more sense when we had a specific denial to address. We're still waiting to hear back from our insurance, but at least it's in their hands right now. I gathered tons and tons of information, studies, statements, etc. that I thought would be useful, but in the end, our first appeal letter was very short (2 pages - I guess it's all relative) and we decided to only address the specific reasons they denied us. When we dissected the denial letter, we came up with 3 reasons that they gave, and we wrote one paragraph about each reason, and even quoted their denial statements when making our arguments. Then we attached the documents that supported those 3 arguments. You'd think that would be sufficient, but we're not dealing with normal human beings, so we're saving all the rest of my research in case we go to round 2 or further. Watch out Cigna!!! I've been told that you have to go through the motions, jump through the hoops, or whatever, until you get to an external review. Hopefully it won't come to that, but I think it's best to play by the rules until then.

Good luck,

Gail

dumb insurance question

This is probably a dumb question but here goes...before I can write anappeal to CCN for denying the DOCband for Mackenzie, do I have to waitfor the denial letter itself? We know it was denied because CT got thecall and received the verbal denial. However, most of the sample appealletters I've seen in the help section here all reference a denial letteritself. Are we spinning our wheels again until we receive the actualwritten denial? Boy, do I hope that all of that made sense...if anybody could help me,I'd really appreciate it. & MackenziePhoenix, AZFor more plagio info

[Guest guest]

Hey no question is ever dumb!!!!! But like the others said-you need the denial to know what you are appealing but definitely get all the stuff together and drafts done so that the day you get it you cans end it in. Make sure you send it certified so they have to sign for it and cant say they never got it. Try these links to help with your appeal.

Good Luck!

beck

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