Health America - denied again!

[Guest guest]

Hi all,

First, I want to thank everyone who has contributed to the

information presented on this site. It has been extremely helpful

for me in preparing my case against Health America and their denial

of coverage for my son 's treatments for positional

plagiocephaly.

We were denied coverage, I appealed, and was denied, and then this

past Tuesday morning I met in front of their " so-called " Member

Satisfaction Committee to present my case once again. I received a

letter tonight indicating that they are still upholding their

original decision because my son's helmet does not meet their

definition of medical necessity.

Normally, I'm a quiet keep to myself and my family kind of guy,

tonight; I'm incredibly pissed off.

How I could have won this last appeal is beyond me, as I feel I could

not have presented our case any better than I did. Thanks to the

help I received from this site and other resources, I was extremely

well prepared, and presented our arguments in a clear, calm, and

confident manner.

Now my options are to turn to the PA Department of Insurance if I'm

still not satisfied. Well, of course I'm not satisfied. I'm pissed,

and I feel like I've been raped for the $1400.00 bill I have in front

of me now.

I'm posting tonight because it feels good to share with people who

understand.

Health America has not heard the last from me, and I cannot believe

anyone with a brain in their head could collect a check from that

company without feeling a sense of guilt for the crap that they're

dishing out on good people.

I'd love to share the information I gathered and the presentation I

made to the committee, but since I LOST this round, I'm not sure I

should as I don't want to muddy the waters for others.

So, after a long wordy post--thanks for listening, I feel a bit

better now--I'm interested in hearing from others who have had

experience dealing with someone like the PA Department of Insurance,

Bureau of Consumer Services. What are my chances, and what help can

I expect to receive from an organization like this?

Thank you!

The facts:

* My son is now nearly 12 months old.

* We've been using the STARband with great success since late January.

* Our pediatric neurologist has been a fantastic guy.

* Ben's now only wearing the helmet at night, and will be done with

it completely in another two weeks.

* Presented letter entitled " Letter of Medical Necessity " from the

Director of Pediatric Neurology at our hospital.

* Among other things, presented AMA positions, FDA classifications,

Journal of Pediatrics qoutes, CSHS quotes, all showing that these

treatments are not cosmetic, are not for appearance only, are

reconstructive, and are being done to correct developmental

deformities, improve function, prevent Ben from further

complications, and ensure his continued good health.