Help w/ denial of insurance coverage

[Guest guest]

Hi

We have gone through the process of getting our son Joe a helmut and

2 months later we are told the insurance will not cover it. We went

through the process correctly and we were told at the time it would

be covered by insurance and now we find out it will not be covered.

Does any one have experience in appealing a denied claim? I am

looking for some tips.

Thanks

Dan

[Guest guest]

Dan,

I am in the process of preparing an appeal right now. There is ample information in the plagio group files, they are very helpful and full of great substantiating information.

Marie Klaszky - PSEG claims specialist/patient advocate

danielmjester <daniel@...> wrote: HiWe have gone through the process of getting our son Joe a helmut and 2 months later we are told the insurance will not cover it. We went through the process correctly and we were told at the time it would be covered by insurance and now we find out it will not be covered. Does any one have experience in appealing a denied claim? I am looking for some tips.ThanksDanFor more plagio info

[Guest guest]

Hi Dan & welcome to our group!

Would you mind giving us a bit more information about both your son &

your insurance. What kind of ins. do you have? Why did they deny

coverage (not medically necessary, etc?)? We have SO many parents in

the group who have or are still currently appealing with their

insurance company to get their child's helmet/band approved. Check

out the " files " section on our board, then " help folder "

then " insurance issues " . Also check out the following website:

http://www.plagiocephaly.org/support then click insurance issues for

more help.

Why type of helmet does Joe have (STARband, DOCband, locally made

helmet)? How old is he?

Welcome again to our group. Best of luck with your ins. battle as

well as your son's rounding head

Debbie Abby's mom DOCgrad

MI

> Hi

> We have gone through the process of getting our son Joe a helmut

and

> 2 months later we are told the insurance will not cover it. We went

> through the process correctly and we were told at the time it would

> be covered by insurance and now we find out it will not be covered.

>

> Does any one have experience in appealing a denied claim? I am

> looking for some tips.

>

> Thanks

> Dan

[Guest guest]

Who are you insured with??? Trisha

danielmjester <daniel@...> wrote: HiWe have gone through the process of getting our son Joe a helmut and 2 months later we are told the insurance will not cover it. We went through the process correctly and we were told at the time it would be covered by insurance and now we find out it will not be covered. Does any one have experience in appealing a denied claim? I am looking for some tips.ThanksDanFor more plagio info

[Guest guest]

Dan,

We have lots of parents in here who are currently in the process of appeals,

or who have successfully had their denials overturned through the appeal

process. If you post your insurance company name, I'm sure you'll get lots

of feedback from those dealing with the same carrier. I know many have

problems with Cigna and some have had Cigna overturn the decision not to pay.

There should be some letters or data in the plagio database as well. Good

luck to you and I hope you can win this battle- its a shame that you have to

fight for what should be automatic coverage, but keep fighting the good fight

all the way-just remember that they want you to give up!

' Mom

[Guest guest]

Hi Dan,

I'm in the process of my first and hopefully

successful appeal with my insurance, BCBS of Oregon (I

live in California). I wasn't quite sure how to even

begin my appeal letter. I did have some research

facts as ammo, but again, " where to begin? " I went

into our groups website into " Files " and into the

Insurance Help folder. There were two great letters

to Coventry insurance that really helped me out as

well as some research articles. My insurance denied

on the basis that according to them the band isn't

" medically necessary. " Also, make sure to visit

www.plagiocephaly.org They have a whole

question-and-answer section about insurance appeals.

Also make sure you go into the Database section of our

group website to see lists of insurance providers who

have approved or denied bands or helmets. It's

amazing to see that some insurance companies approve

some and deny others. I saw that BCBS of North

Carolina paid %100 for the same treatment as my

daughter with the same circumstances as my daughter.

Stuff like this can be used as ammo in your letter.

Good luck and keep fighting to try to wear them down

and pay for what our babies deserve and medically

need!

, 's mom

Southern California

--- danielmjester <daniel@...> wrote:

> Hi

> We have gone through the process of getting our son

> Joe a helmut and

> 2 months later we are told the insurance will not

> cover it. We went

> through the process correctly and we were told at

> the time it would

> be covered by insurance and now we find out it will

> not be covered.

>

> Does any one have experience in appealing a denied

> claim? I am

> looking for some tips.

>

> Thanks

> Dan

>

>

>

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