Re: Insurance denial- external review process?

[Guest guest]

Hi Jen,

I don't have any answers for you, I'm sorry. I just wanted to wish you

good luck! Please let us know how it goes.

-- In Plagiocephaly , " emsar14 " <jengruber@...> wrote:

>

> Hi,

>

> Just wondering if anyone has ever gone through an " external review "

> after being denied by their insurance for the helmet? We have been

> twice denied by Humana and now our appeal is in the hands of the State

> of Michigan. Has anyone dealt with this? Has anyone had a favorable

> outcome???

>

> Thanks!

> Jen (mom to 10 mos; banded 1/25/06, and Emma 4 yrs.)

>

[Guest guest]

Hi Jen,

I don't have any answers for you, I'm sorry. I just wanted to wish you

good luck! Please let us know how it goes.

-- In Plagiocephaly , " emsar14 " <jengruber@...> wrote:

>

> Hi,

>

> Just wondering if anyone has ever gone through an " external review "

> after being denied by their insurance for the helmet? We have been

> twice denied by Humana and now our appeal is in the hands of the State

> of Michigan. Has anyone dealt with this? Has anyone had a favorable

> outcome???

>

> Thanks!

> Jen (mom to 10 mos; banded 1/25/06, and Emma 4 yrs.)

>

[Guest guest]

Hi,

We're currently undergoing a review thru the State of land

Insurance Administration... we were denied and lost 2 appeals to

Aetna.

Lynne

--- In Plagiocephaly , " emsar14 " <jengruber@...>

wrote:

>

> Hi,

>

> Just wondering if anyone has ever gone through an " external

review "

> after being denied by their insurance for the helmet? We have

been

> twice denied by Humana and now our appeal is in the hands of the

State

> of Michigan. Has anyone dealt with this? Has anyone had a

favorable

> outcome???

>

> Thanks!

> Jen (mom to 10 mos; banded 1/25/06, and Emma 4 yrs.)

>

[Guest guest]

Hi,

We're currently undergoing a review thru the State of land

Insurance Administration... we were denied and lost 2 appeals to

Aetna.

Lynne

--- In Plagiocephaly , " emsar14 " <jengruber@...>

wrote:

>

> Hi,

>

> Just wondering if anyone has ever gone through an " external

review "

> after being denied by their insurance for the helmet? We have

been

> twice denied by Humana and now our appeal is in the hands of the

State

> of Michigan. Has anyone dealt with this? Has anyone had a

favorable

> outcome???

>

> Thanks!

> Jen (mom to 10 mos; banded 1/25/06, and Emma 4 yrs.)

>

[Guest guest]

I just talked to the State of Michigan today. They said it doesn't

look good for us. Since Humana is simply calling it a " contract

exclusion " , there is not much we can do. They said we can go to

court, but I'm sure I'll end up spending more than the helmet

actually costs!

Good luck and please let me know if you win!

Jen

> >

> > Hi,

> >

> > Just wondering if anyone has ever gone through an " external

> review "

> > after being denied by their insurance for the helmet? We have

> been

> > twice denied by Humana and now our appeal is in the hands of the

> State

> > of Michigan. Has anyone dealt with this? Has anyone had a

> favorable

> > outcome???

> >

> > Thanks!

> > Jen (mom to 10 mos; banded 1/25/06, and Emma 4 yrs.)

> >

>

[Guest guest]

I just talked to the State of Michigan today. They said it doesn't

look good for us. Since Humana is simply calling it a " contract

exclusion " , there is not much we can do. They said we can go to

court, but I'm sure I'll end up spending more than the helmet

actually costs!

Good luck and please let me know if you win!

Jen

> >

> > Hi,

> >

> > Just wondering if anyone has ever gone through an " external

> review "

> > after being denied by their insurance for the helmet? We have

> been

> > twice denied by Humana and now our appeal is in the hands of the

> State

> > of Michigan. Has anyone dealt with this? Has anyone had a

> favorable

> > outcome???

> >

> > Thanks!

> > Jen (mom to 10 mos; banded 1/25/06, and Emma 4 yrs.)

> >

>

[Guest guest]

Hi Lynne,

I did just go through that process in Arizona with

BCBS. Unfortunetly I did not have a favorable outcome.

The sad part is they (the medical appeal commitee of

BCBS as well as the external commitee both made the

determination that it was not medically necessary),

when my son's ped as well as cran. tech. both wrote

letters stating that his severity of plagio and tort,

deemed the doc band is medically nec. It just seems

like they will find some way of excluding this type of

coverage, irreguardless of the fact that his Dr.

determined the doc band to be the method of treatment.

I wish you luck and hope you get a much better outcome

than I.

Maureen

--- lyndeylou7 <lynnemjurgielewicz@...>

wrote:

> Hi,

> We're currently undergoing a review thru the State

> of land

> Insurance Administration... we were denied and lost

> 2 appeals to

> Aetna.

> Lynne

>

>

>

> >

> > Hi,

> >

> > Just wondering if anyone has ever gone through an

> " external

> review "

> > after being denied by their insurance for the

> helmet? We have

> been

> > twice denied by Humana and now our appeal is in

> the hands of the

> State

> > of Michigan. Has anyone dealt with this? Has

> anyone had a

> favorable

> > outcome???

> >

> > Thanks!

> > Jen (mom to 10 mos; banded 1/25/06, and Emma

> 4 yrs.)

> >

>

>

>

>

>

>

>

>

__________________________________________________

[Guest guest]

Hi Lynne,

I did just go through that process in Arizona with

BCBS. Unfortunetly I did not have a favorable outcome.

The sad part is they (the medical appeal commitee of

BCBS as well as the external commitee both made the

determination that it was not medically necessary),

when my son's ped as well as cran. tech. both wrote

letters stating that his severity of plagio and tort,

deemed the doc band is medically nec. It just seems

like they will find some way of excluding this type of

coverage, irreguardless of the fact that his Dr.

determined the doc band to be the method of treatment.

I wish you luck and hope you get a much better outcome

than I.

Maureen

--- lyndeylou7 <lynnemjurgielewicz@...>

wrote:

> Hi,

> We're currently undergoing a review thru the State

> of land

> Insurance Administration... we were denied and lost

> 2 appeals to

> Aetna.

> Lynne

>

>

>

> >

> > Hi,

> >

> > Just wondering if anyone has ever gone through an

> " external

> review "

> > after being denied by their insurance for the

> helmet? We have

> been

> > twice denied by Humana and now our appeal is in

> the hands of the

> State

> > of Michigan. Has anyone dealt with this? Has

> anyone had a

> favorable

> > outcome???

> >

> > Thanks!

> > Jen (mom to 10 mos; banded 1/25/06, and Emma

> 4 yrs.)

> >

>

>

>

>

>

>

>

>

__________________________________________________