Guest guest Posted July 25, 2002 Report Share Posted July 25, 2002 Well I just got the denial letter from Anthem. (Which i knew it was denied...and i'm going to be using Guardian now anyway..so hopefully they'll pay)...but the reason it was denied was b/c they consider it experimental and investigative..so they won't pay for that. What can you do to overturn that decision? I'm not even going to try..since i'm going to have Guardian now..but in case they deny me for the same thing? How do you prove it's not experimental? (Trisha, i'm still looking through all your stuff..lol..thanks!!) Mom to Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 25, 2002 Report Share Posted July 25, 2002 : I am pretty sure Tim L of CT wrote up a letter about this and it's in our Files Section - Help Folder - Insurance issues. Check that out & print out the letter just in case you'll need it with Guardian. Debbie abby's mom DOCgrad MI > Well I just got the denial letter from Anthem. (Which i knew it was denied...and i'm going to be using Guardian now anyway..so hopefully they'll pay)...but the reason it was denied was b/c they consider it experimental and investigative..so they won't pay for that. What can you do to overturn that decision? I'm not even going to try..since i'm going to have Guardian now..but in case they deny me for the same thing? How do you prove it's not experimental? (Trisha, i'm still looking through all your stuff..lol..thanks!!) > > > Mom to Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 25, 2002 Report Share Posted July 25, 2002 Thanks so much Debbie!! In a message dated Thu, 25 Jul 2002 10:48:04 AM Eastern Standard Time, dj2kirby@... writes: > > > : > I am pretty sure Tim L of CT wrote up a letter about this and it's in > our Files Section - Help Folder - Insurance issues. Check that out & > print out the letter just in case you'll need it with Guardian. > Debbie abby's mom DOCgrad > MI > > > > Well I just got the denial letter from Anthem. (Which i knew it > was denied...and i'm going to be using Guardian now anyway..so > hopefully they'll pay)...but the reason it was denied was b/c they > consider it experimental and investigative..so they won't pay for > that. What can you do to overturn that decision? I'm not even going > to try..since i'm going to have Guardian now..but in case they deny > me for the same thing? How do you prove it's not experimental? > (Trisha, i'm still looking through all your stuff..lol..thanks!!) > > > > > > Mom to > > > > For more plagio info Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 27, 2004 Report Share Posted June 27, 2004 , You might try asking the Cranial Tech clinic that you use for information. The one we used in Connecticut said they couldn't help me make an appeal -but they did provide me with a packet of information on appeals and sample appeals letters, etc. It was very useful. Thats probably something that the central office put together so you could probably get one through your office too. Best Wishes, - > Howdy, all. I haven't even formally submitted the claim for 's > DOC Band, and already I got a denial letter. > > The letter says that the medical review concluded 's care was > appropriate and met community standards, and uses the phrase " elected > banding procedure, " implying that it is elective and therefore not > necessary. They decline to reimburse me. > > My big problem is that I don't have a doctor willing to go to bat for > me, saying that he recommends a band. 's HMO ped refused to > write a prescription because he said if he did, the HMO would have to > pay for the band. I had to go outside the system to a referral doc > they use and beg her to write the Rx, and she said she wouldn't back > me if I tried to get insurance reimbursement. I told her I wasn't > going to bother, but now I've changed my mind. The HMO blew him off, > and I think it was deliberate, since around here if you don't get the > child into treatment before a year, there are no treatment options > (only passive bands in Seattle). If the kid can't get treated, the > HMO doesn't have to pay. Verrrry convenient for the HMO, no? > > Anyway, so I don't have a doc to say should have a band. > Cranial Tech's measurements put him in the moderate range, and his > numbers are about the same as a lot of kids on this board. I think > this makes the HMO look even worse, since he was denied care that I > was begging for and that other kids with the same condition were > given. From what I understand, it isn't up to the peds to override > what I want for my child. Right? I mean, it's one thing for an > insurance company to deny a claim, but I think it's terrible for a > pediatrician to flat-out deny treatment based on money (he was very > up front about this)! > > What do I do now? I'm going to appeal. If anyone has any suggestions > for what to say or what paperwork to include, I would be very > grateful. I'm a little overwhelmed. > > > , 19 mos, tort, DOC Band 5/7 Quote Link to comment Share on other sites More sharing options...
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