Re: [SPAM] Help!!! United Healthcare Denial

[Guest guest]

Jeff,

I just got back from a meeting with my attorney about this issue. I'm not sure which plan you have with UHC,(or what was in your first appeal letter) but this is how I was instructed to draft my appeal letter. Under my plan, Durable Medical Equipment is covered. A DOC Band classifies as Durable Medical Equipment, because it meets all the criteria for durable medical equipment. A DOC Band is :

1)Ordered or provided by a Physician for outpatient use

2) Used for medical purposes

3) Not consumable or disposable

4) Not of use to a person in the absence of a disease or disability

"If more than one piece of Durable Medical Equipment can meet your functional needs, Benefits are available for the cost effective piece of equipment."

In regards to the policy exclusion- "braces that straighten or change the shape of a body part are orthotic devices." A DOC band corrects the abnormality on a child that most of the time is caused inutro. (My son's plagio was caused by the how he was positioned inutro). So the DOC band isn't providing a cosmetic purpose, it is fixing a birth defect (at least this is the case with my son). An orthotic device that changes the shape of a body part is more along the lines of dental braces/retainer...

Sorry this is a bit long, I hope some of this can help you out.

Best of luck

Lorie

Mom to Spencer and Alizabeth 1 year

Spencer- Left Plagio- DOC Band GRAD 9/07-12/07

Glendale, AZ

[sPAM] Help!!! United Healthcare Denial

We received a denial from United Healthcare. It indicates "orthotic appliances that straighten or re-shape a body (including some sorts of braces)" are excluded from coverage.Has any one had success in the appeals process with United Healthcare for this specific denial? Any help you could offer would be most appreciated.Thanks,JeffFather to 8 months old

[Guest guest]

Lorie,

Thanks for all the great information. Once you draft your appeals

letter I would love to have a copy if you wouldn't mind sharing it

(I can do the same, but mine is probably not going to be done for

another week or two). How were you able to come to the conclusion

that your son's plagio was caused by how he was positioned inutroly?

Thanks again for all of your sharing all your knowledge on this.

Jeff

>

> Jeff,

> I just got back from a meeting with my attorney about this

issue. I'm not sure which plan you have with UHC,(or what was in

your first appeal letter) but this is how I was instructed to draft

my appeal letter. Under my plan, Durable Medical Equipment is

covered. A DOC Band classifies as Durable Medical Equipment, because

it meets all the criteria for durable medical equipment. A DOC Band

is :

> 1)Ordered or provided by a Physician for outpatient use

> 2) Used for medical purposes

> 3) Not consumable or disposable

> 4) Not of use to a person in the absence of a disease or

disability

> " If more than one piece of Durable Medical Equipment can meet your

functional needs, Benefits are available for the cost effective piece

of equipment. "

>

> In regards to the policy exclusion- " braces that straighten or

change the shape of a body part are orthotic devices. " A DOC band

corrects the abnormality on a child that most of the time is caused

inutro. (My son's plagio was caused by the how he was positioned

inutro). So the DOC band isn't providing a cosmetic purpose, it is

fixing a birth defect (at least this is the case with my son). An

orthotic device that changes the shape of a body part is more along

the lines of dental braces/retainer...

>

> Sorry this is a bit long, I hope some of this can help you out.

>

>

> Best of luck

>

> Lorie

> Mom to Spencer and Alizabeth 1 year

> Spencer- Left Plagio- DOC Band GRAD 9/07-12/07

> Glendale, AZ

> [sPAM] Help!!! United Healthcare Denial

>

>

> We received a denial from United Healthcare. It

indicates " orthotic

> appliances that straighten or re-shape a body (including some

sorts of

> braces) " are excluded from coverage.

>

> Has any one had success in the appeals process with United

Healthcare

> for this specific denial? Any help you could offer would be most

> appreciated.

>

> Thanks,

>

> Jeff

> Father to

> 8 months old

>

[Guest guest]

Lorie,

That sounds like great advice. We were thinking of using the same

argument, but your phasing is a little bit nicer than what I really

want to say to UHC. Good luck to with your appeal too.

Jenn

>

> Jeff,

> I just got back from a meeting with my attorney about this

issue. I'm not sure which plan you have with UHC,(or what was in

your first appeal letter) but this is how I was instructed to draft

my appeal letter. Under my plan, Durable Medical Equipment is

covered. A DOC Band classifies as Durable Medical Equipment, because

it meets all the criteria for durable medical equipment. A DOC Band

is :

> 1)Ordered or provided by a Physician for outpatient use

> 2) Used for medical purposes

> 3) Not consumable or disposable

> 4) Not of use to a person in the absence of a disease or

disability

> " If more than one piece of Durable Medical Equipment can meet your

functional needs, Benefits are available for the cost effective piece

of equipment. "

>

> In regards to the policy exclusion- " braces that straighten or

change the shape of a body part are orthotic devices. " A DOC band

corrects the abnormality on a child that most of the time is caused

inutro. (My son's plagio was caused by the how he was positioned

inutro). So the DOC band isn't providing a cosmetic purpose, it is

fixing a birth defect (at least this is the case with my son). An

orthotic device that changes the shape of a body part is more along

the lines of dental braces/retainer...

>

> Sorry this is a bit long, I hope some of this can help you out.

>

>

> Best of luck

>

> Lorie

> Mom to Spencer and Alizabeth 1 year

> Spencer- Left Plagio- DOC Band GRAD 9/07-12/07

> Glendale, AZ

> [sPAM] Help!!! United Healthcare Denial

>

>

> We received a denial from United Healthcare. It

indicates " orthotic

> appliances that straighten or re-shape a body (including some

sorts of

> braces) " are excluded from coverage.

>

> Has any one had success in the appeals process with United

Healthcare

> for this specific denial? Any help you could offer would be most

> appreciated.

>

> Thanks,

>

> Jeff

> Father to

> 8 months old

>

[Guest guest]

We also received a denial. it only covers if the baby had sursery. jrmcgrath71 <mcgrathjk@...> wrote: Lorie,Thanks for all the great information. Once you draft your appeals letter I would love to have a copy if you wouldn't mind sharing it (I can do the same, but mine is probably not going to be done for another week or two). How were you able to come to the conclusion that your son's plagio was caused by how he was positioned

inutroly?Thanks again for all of your sharing all your knowledge on this.Jeff >> Jeff,> I just got back from a meeting with my attorney about this issue. I'm not sure which plan you have with UHC,(or what was in your first appeal letter) but this is how I was instructed to draft my appeal letter. Under my plan, Durable Medical Equipment is covered. A DOC Band classifies as Durable Medical Equipment, because it meets all the criteria for durable medical equipment. A DOC Band is : > 1)Ordered or provided by a Physician for outpatient use> 2) Used for medical purposes> 3) Not consumable or disposable> 4) Not of use to a person in the absence of a disease or disability> "If more than one piece of Durable Medical

Equipment can meet your functional needs, Benefits are available for the cost effective piece of equipment."> > In regards to the policy exclusion- "braces that straighten or change the shape of a body part are orthotic devices." A DOC band corrects the abnormality on a child that most of the time is caused inutro. (My son's plagio was caused by the how he was positioned inutro). So the DOC band isn't providing a cosmetic purpose, it is fixing a birth defect (at least this is the case with my son). An orthotic device that changes the shape of a body part is more along the lines of dental braces/retainer... > > Sorry this is a bit long, I hope some of this can help you out. > > > Best of luck> > Lorie> Mom to Spencer and Alizabeth 1 year> Spencer- Left Plagio- DOC Band GRAD 9/07-12/07> Glendale, AZ> [sPAM] Help!!! United Healthcare Denial> > > We received a denial from United Healthcare. It indicates "orthotic > appliances that straighten or re-shape a body (including some sorts of > braces)" are excluded from coverage.> > Has any one had success in the appeals process with United Healthcare > for this specific denial? Any help you could offer would be most > appreciated.> > Thanks,> > Jeff> Father to > 8 months old>

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