Guest guest Posted August 11, 2002 Report Share Posted August 11, 2002 Hello everyone. This is the first time that I've visited this group. I have four month old twin girls that have been diagnosed with torticollis and have severe plagiocephaly. I contacted the insurance company and provided them with the information they said they initially needed to approve the DOC bands: letter of medical necessity, prescription for DOC bands, insurance card, and pictures/measurements of the girls heads. I waited over three weeks for an approval. While I waited, I made an appointment with the DOC band office to get the girls casted, since time is of the essence. The insurance company kept telling me on the phone it would be any day and would get me my approval. The appointment finally came and I got the girls casted and the next day they gave me a denial saying that the DOC band was " cosmetic " . I have appealed their decision and they came back with the same answer. The insurance company acknowledges that the girls have torticollis and that the torticollis caused the plagiocephaly. My problem is while the torticollis is recognized as a medical condition, however the plagiocephaly is not. So since the band is treating the plagiocephaly and not the torticollis, the procedure is listed as cosmetic and not medically necessary (even though I have letters saying otherwise). HELP!!! How can I prove to the insurance company that plagiocephaly is a " medical " condition (especially since the congenital torticollis IS a medical condition)??? And if I even get that far, will the insurance company reject me anyhow if I got the denial letter the next day after the girls were casted?? (The DOC band office told me that backdating the approval from the insurance company wouldn't be a problem.... I didn't realize it might be a problem until after I read other testimonies and articiles on the website.) Please advise.... Any assistance would be greatly appreciated... Thanks!!! My problem is with the insurance company. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 12, 2002 Report Share Posted August 12, 2002 Hi & welcome to our group! Ahhh, yet another insurance sufferer :'(. So sorry to hear of your denial. What insurance do you have? There is some help in our group " Files " section, then " help folder " then " insurance folder " - there are copies of appeals letters and many other ins. articles that might help. Also look at http://www.plagiocephaly.org/support then " insurance issues " for more help. Have your twins rec'd their DOCbands now? If so, how have they been doing? Any improvment yet? They're at a perfect young age to get fast & wonderful correction. How did they handle the casting? Are they in physical therapy for their tort? I know you'll get lots of members offering help with your ins. fight, we have many people currently fighting their ins and others who have previously. My #1 piece of advice is to never give up. Appeal, appeal & appeal! Welcome again..please keep us posted. Debbie Abby's mom DOCgrad MI > Hello everyone. This is the first time that I've visited this > group. I have four month old twin girls that have been diagnosed > with torticollis and have severe plagiocephaly. I contacted the > insurance company and provided them with the information they said > they initially needed to approve the DOC bands: letter of medical > necessity, prescription for DOC bands, insurance card, and > pictures/measurements of the girls heads. > > I waited over three weeks for an approval. While I waited, I made an > appointment with the DOC band office to get the girls casted, since > time is of the essence. The insurance company kept telling me on the > phone it would be any day and would get me my approval. The > appointment finally came and I got the girls casted and the next day > they gave me a denial saying that the DOC band was " cosmetic " . I > have appealed their decision and they came back with the same answer. > > The insurance company acknowledges that the girls have torticollis > and that the torticollis caused the plagiocephaly. My problem is > while the torticollis is recognized as a medical condition, however > the plagiocephaly is not. So since the band is treating the > plagiocephaly and not the torticollis, the procedure is listed as > cosmetic and not medically necessary (even though I have letters > saying otherwise). > > HELP!!! How can I prove to the insurance company that plagiocephaly > is a " medical " condition (especially since the congenital torticollis > IS a medical condition)??? And if I even get that far, will the > insurance company reject me anyhow if I got the denial letter the > next day after the girls were casted?? (The DOC band office told me > that backdating the approval from the insurance company wouldn't be a > problem.... I didn't realize it might be a problem until after I read > other testimonies and articiles on the website.) > > Please advise.... Any assistance would be greatly appreciated... > Thanks!!! > > > > My problem is with the insurance company. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 12, 2002 Report Share Posted August 12, 2002 There is a really great article in the files section that is about how torticollis can cause plagio. It is tort.rtf (I believe). That should help you a bit. You can also get some great articles on cranialtech.com that point to the fact that it is reconstructive rather than cosmetic. Good luck! Dane's mom DOC Grad > Hello everyone. This is the first time that I've visited this > group. I have four month old twin girls that have been diagnosed > with torticollis and have severe plagiocephaly. I contacted the > insurance company and provided them with the information they said > they initially needed to approve the DOC bands: letter of medical > necessity, prescription for DOC bands, insurance card, and > pictures/measurements of the girls heads. > > I waited over three weeks for an approval. While I waited, I made an > appointment with the DOC band office to get the girls casted, since > time is of the essence. The insurance company kept telling me on the > phone it would be any day and would get me my approval. The > appointment finally came and I got the girls casted and the next day > they gave me a denial saying that the DOC band was " cosmetic " . I > have appealed their decision and they came back with the same answer. > > The insurance company acknowledges that the girls have torticollis > and that the torticollis caused the plagiocephaly. My problem is > while the torticollis is recognized as a medical condition, however > the plagiocephaly is not. So since the band is treating the > plagiocephaly and not the torticollis, the procedure is listed as > cosmetic and not medically necessary (even though I have letters > saying otherwise). > > HELP!!! How can I prove to the insurance company that plagiocephaly > is a " medical " condition (especially since the congenital torticollis > IS a medical condition)??? And if I even get that far, will the > insurance company reject me anyhow if I got the denial letter the > next day after the girls were casted?? (The DOC band office told me > that backdating the approval from the insurance company wouldn't be a > problem.... I didn't realize it might be a problem until after I read > other testimonies and articiles on the website.) > > Please advise.... Any assistance would be greatly appreciated... > Thanks!!! > > > > My problem is with the insurance company. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 12, 2002 Report Share Posted August 12, 2002 Thank you for the warm welcome, and thank you and the others that replied to my plea for help. I found the letters in the insurance folder and LOVED them... they will be a great help. My insurance that I'm battling with is PPO of Oklahoma. Yes, we went ahead with the DOCband procedure and they are wearing them now. One of girls had a meltdown with the casting, but the other just took it in stride (with a bottle in the mouth, of course). They started wearing the bands at about 3 1/2 months old, and we can already see MAJOR improvements in just a couple weeks!!! They started their physicial therapy for the torticollis about a month ago, and that's actually a slower improvement process for us. Thanks again for the information and support. I'm already on my second appeal and have no plans of stopping... Thanks again, and I'll keep in touch!! Oklahoma > > Hello everyone. This is the first time that I've visited this > > group. I have four month old twin girls that have been diagnosed > > with torticollis and have severe plagiocephaly. I contacted the > > insurance company and provided them with the information they said > > they initially needed to approve the DOC bands: letter of medical > > necessity, prescription for DOC bands, insurance card, and > > pictures/measurements of the girls heads. > > > > I waited over three weeks for an approval. While I waited, I made > an > > appointment with the DOC band office to get the girls casted, since > > time is of the essence. The insurance company kept telling me on > the > > phone it would be any day and would get me my approval. The > > appointment finally came and I got the girls casted and the next > day > > they gave me a denial saying that the DOC band was " cosmetic " . I > > have appealed their decision and they came back with the same > answer. > > > > The insurance company acknowledges that the girls have torticollis > > and that the torticollis caused the plagiocephaly. My problem is > > while the torticollis is recognized as a medical condition, however > > the plagiocephaly is not. So since the band is treating the > > plagiocephaly and not the torticollis, the procedure is listed as > > cosmetic and not medically necessary (even though I have letters > > saying otherwise). > > > > HELP!!! How can I prove to the insurance company that > plagiocephaly > > is a " medical " condition (especially since the congenital > torticollis > > IS a medical condition)??? And if I even get that far, will the > > insurance company reject me anyhow if I got the denial letter the > > next day after the girls were casted?? (The DOC band office told > me > > that backdating the approval from the insurance company wouldn't be > a > > problem.... I didn't realize it might be a problem until after I > read > > other testimonies and articiles on the website.) > > > > Please advise.... Any assistance would be greatly appreciated... > > Thanks!!! > > > > > > > > My problem is with the insurance company. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 12, 2002 Report Share Posted August 12, 2002 Hello, my name is Trisha I just beat Cigna and got them to pay 100% for my sons band. He too has Torticollis and Plagio & Brachy he had it Mod/Sev. degree. If you would like I can send you a copy of my appeals packet. Just let me know...but e-mail me at my work so I can get it faster. Trisham@... I am on a mission to help anyone beat these freaking insurance companies....Everyone can tell you I get a little Fiesty but hey thats my nature when it comes to kids. Trisha > > > Hello everyone. This is the first time that I've visited this > > > group. I have four month old twin girls that have been diagnosed > > > with torticollis and have severe plagiocephaly. I contacted the > > > insurance company and provided them with the information they > said > > > they initially needed to approve the DOC bands: letter of > medical > > > necessity, prescription for DOC bands, insurance card, and > > > pictures/measurements of the girls heads. > > > > > > I waited over three weeks for an approval. While I waited, I > made > > an > > > appointment with the DOC band office to get the girls casted, > since > > > time is of the essence. The insurance company kept telling me on > > the > > > phone it would be any day and would get me my approval. The > > > appointment finally came and I got the girls casted and the next > > day > > > they gave me a denial saying that the DOC band was " cosmetic " . I > > > have appealed their decision and they came back with the same > > answer. > > > > > > The insurance company acknowledges that the girls have > torticollis > > > and that the torticollis caused the plagiocephaly. My problem is > > > while the torticollis is recognized as a medical condition, > however > > > the plagiocephaly is not. So since the band is treating the > > > plagiocephaly and not the torticollis, the procedure is listed as > > > cosmetic and not medically necessary (even though I have letters > > > saying otherwise). > > > > > > HELP!!! How can I prove to the insurance company that > > plagiocephaly > > > is a " medical " condition (especially since the congenital > > torticollis > > > IS a medical condition)??? And if I even get that far, will the > > > insurance company reject me anyhow if I got the denial letter the > > > next day after the girls were casted?? (The DOC band office told > > me > > > that backdating the approval from the insurance company wouldn't > be > > a > > > problem.... I didn't realize it might be a problem until after I > > read > > > other testimonies and articiles on the website.) > > > > > > Please advise.... Any assistance would be greatly appreciated... > > > Thanks!!! > > > > > > > > > > > > My problem is with the insurance company. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 12, 2002 Report Share Posted August 12, 2002 Hello and I'm sorry that it has taken me so long to respond. What a bummer about the insurance company and all the trouble you have experienced. I read in a later post from you that you have PPO Oklahoma as your network. I hope that you are successful with your appeal. There is certainly enough evidence out there to prove that treatment for plagiocephaly is not purely cosmetic and the treatment should be considered medically necessary. I was insured through Healthcare Oklahoma at the time my daughter was wearing her helmet. We were denied at every appeal level and ultimately had to have our claim sent to an External Review Board. The External Review Board was conducted by the Oklahoma Foundation for Medical Quality and they overturned Healthcare Oklahoma's denial and they were forced to pay! So appeals can be effective, but if you don't succeed with that there are other options to explore. Best of luck and it's good to have another Oklahoman amongst the members. Marci (Mom to ) Oklahoma Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 14, 2002 Report Share Posted August 14, 2002 In a message dated 8/12/2002 2:19:01 AM Eastern Daylight Time, debc@... writes: They started their physicial therapy for the torticollis about a month ago, and that's actually a slower improvement process for us. OK, This was the hardest part for me too- for most kids tort is not an overnight fix, and you have to be patient- so hard when you want your kids all better, now! Hang in there, just like the DOC band, before you know it, months have gone by and progress is very apparent! ' Mom Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 23, 2002 Report Share Posted October 23, 2002 Hi : Welcome to our group! Check out this site for insurance help http://www.plagiocephaly.org/support then click " insurance " for some good tips. You can also find more info in our groups " files " section " help folder " then " insurance " . Do you have a letter of medical necessity from your dr for Luke's band? If not, maybe that will help. Is Luke currently wearing a band or helmet? If so, how's it going? Any improvment? He's at a great age to get good & fast correction. Sounds like ins. is giving you a lot of trouble right now. Also with phys therapy too huh? What a shame. Good luck, welcome again. Debbie Abby's mom DOCGrad MI > > > Help.... . > > Can anyone give me some advice on appealing the insurances > decision. They said the cranial banning was not medically necessary. > Luke is 5 months old now, he was born with right sided tort. we have > also been changed to once a month physical therapy. I am getting so > frustrated. I forgot to mention our insurance is medcost (Marsh > Advantage). > > > > Thanks, > > > > and Luke Quote Link to comment Share on other sites More sharing options...
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