Re: New to group, question about appealing insurance denial

[Guest guest]

Hi and welcome to the group. lots of insurance companies (including

UHC) routinely deny. There are a lot of sample appeal letters in the

files section of this group. One thing would be to get them to deny in

writing and state their reason - then you'll have something to

address. I hope that you will get them to pay, but it can take

several appeals, and they still may not pay. Don't be too discouraged

though because a lot of people do win the appeal.

Best of luck with it.

-christine

sydney 2 yrs starband grad

>

> Hi. I am new to this group and happy to have found you. It's nice to

> know there are others out there with our same plight. My son has been

> wearing his band now for almost 14 weeks. There are little if any more

> adjustments that can be made to this one and our neuro says he may need

> a second one. We submitted the claim for the first one to two

> insurance companies in the hope that between them we would get the

> whole thing covered. (Both my husband and I are carrying insurance

> through our jobs...CIGNA and UHC). This alone is costing us extra

> money but we are doing it b/c our son has multiple health issues.

> Anyway, both companies have denied the claim. My husband and I are

> beside ourselves. Not that there isn't anything we wouldn't do for our

> son, but we are already financially strapped from having to pay the

> almost $3000 for the first band (we have since borrowed money from his

> mom and my dad). Does anybody have any advice on how we should appeal

> this and what any of you who have had to appeal have done to be

> successful. I don't want to comprimise my son's progress, but if the

> insurance doesn't pay anything, a second band is out of the question.

> Looking for any help and/or advice. Thanks.

>

[Guest guest]

I just wanted to let you know that we were able to successfully fight

an appeal with UHC. We recieved 3 denials from them, but would not

take no for an answer. We were finally told by UHC that we needed to

contact the HR dept of dh's company, when we did we sent them a

letter stating the reasons we wanted our son to have

his helmet. We used examples found in appeals found on this sight, we

informed them that we didnt want to take a chance with our sons

future health and not band him. I wish you luck with your appeals,

and dont give up with just 1. I was in tears many times this past

summer over the denial letters.

mom to

Jack starband grad Nov 07

>

> Hi. I am new to this group and happy to have found you. It's nice

to

> know there are others out there with our same plight. My son has

been

> wearing his band now for almost 14 weeks. There are little if any

more

> adjustments that can be made to this one and our neuro says he may

need

> a second one. We submitted the claim for the first one to two

> insurance companies in the hope that between them we would get the

> whole thing covered. (Both my husband and I are carrying insurance

> through our jobs...CIGNA and UHC). This alone is costing us extra

> money but we are doing it b/c our son has multiple health issues.

> Anyway, both companies have denied the claim. My husband and I are

> beside ourselves. Not that there isn't anything we wouldn't do for

our

> son, but we are already financially strapped from having to pay the

> almost $3000 for the first band (we have since borrowed money from

his

> mom and my dad). Does anybody have any advice on how we should

appeal

> this and what any of you who have had to appeal have done to be

> successful. I don't want to comprimise my son's progress, but if

the

> insurance doesn't pay anything, a second band is out of the

question.

> Looking for any help and/or advice. Thanks.

>

[Guest guest]

We were also able to get UHC to cover our daughter's helmet by

contacting DH's HR dept. I work in the insurance industry and I can

tell you going through your HR is absolutely the fastest and most

effective way to get results. UHC or any other insurance company

for that matter aren't incredibly concerned if you're not happy but

they will care if their client is not happy so I would definitely

try your HR.

> >

> > Hi. I am new to this group and happy to have found you. It's

nice

> to

> > know there are others out there with our same plight. My son

has

> been

> > wearing his band now for almost 14 weeks. There are little if

any

> more

> > adjustments that can be made to this one and our neuro says he

may

> need

> > a second one. We submitted the claim for the first one to two

> > insurance companies in the hope that between them we would get

the

> > whole thing covered. (Both my husband and I are carrying

insurance

> > through our jobs...CIGNA and UHC). This alone is costing us

extra

> > money but we are doing it b/c our son has multiple health

issues.

> > Anyway, both companies have denied the claim. My husband and I

are

> > beside ourselves. Not that there isn't anything we wouldn't do

for

> our

> > son, but we are already financially strapped from having to pay

the

> > almost $3000 for the first band (we have since borrowed money

from

> his

> > mom and my dad). Does anybody have any advice on how we should

> appeal

> > this and what any of you who have had to appeal have done to be

> > successful. I don't want to comprimise my son's progress, but

if

> the

> > insurance doesn't pay anything, a second band is out of the

> question.

> > Looking for any help and/or advice. Thanks.

> >

>

[Guest guest]

Email me and I will send you a copy of my succesful UHC appeal.

lka_236@...

> >

> > Hi. I am new to this group and happy to have found you. It's

nice

> to

> > know there are others out there with our same plight. My son

has

> been

> > wearing his band now for almost 14 weeks. There are little if

any

> more

> > adjustments that can be made to this one and our neuro says he

may

> need

> > a second one. We submitted the claim for the first one to two

> > insurance companies in the hope that between them we would get

the

> > whole thing covered. (Both my husband and I are carrying

insurance

> > through our jobs...CIGNA and UHC). This alone is costing us

extra

> > money but we are doing it b/c our son has multiple health

issues.

> > Anyway, both companies have denied the claim. My husband and I

are

> > beside ourselves. Not that there isn't anything we wouldn't do

for

> our

> > son, but we are already financially strapped from having to pay

the

> > almost $3000 for the first band (we have since borrowed money

from

> his

> > mom and my dad). Does anybody have any advice on how we should

> appeal

> > this and what any of you who have had to appeal have done to be

> > successful. I don't want to comprimise my son's progress, but

if

> the

> > insurance doesn't pay anything, a second band is out of the

> question.

> > Looking for any help and/or advice. Thanks.

> >

>

[Guest guest]

I had trouble getting the insurance to cover my sons helmet but the orthotits took lots of pictures and sent them to show how severe the condition was and i was approved..hniemeyer74 <hniemeyer74@...> wrote: We were also able to get UHC to cover our daughter's helmet by contacting DH's HR dept. I work in the insurance industry and I can tell you going through your HR is absolutely the fastest and most effective way to get results. UHC or any other insurance company for that matter aren't incredibly concerned if

you're not happy but they will care if their client is not happy so I would definitely try your HR.> >> > Hi. I am new to this group and happy to have found you. It's nice > to > > know there are others out there with our same plight. My son has > been > > wearing his band now for almost 14 weeks. There are little if any > more > > adjustments that can be made to this one and our neuro says he may > need > > a second one. We submitted the claim for the first one to two > > insurance companies in the hope that between them we would get the > > whole thing covered. (Both my husband and I are carrying insurance > > through our jobs...CIGNA and UHC). This alone is costing us extra

> > money but we are doing it b/c our son has multiple health issues. > > Anyway, both companies have denied the claim. My husband and I are > > beside ourselves. Not that there isn't anything we wouldn't do for > our > > son, but we are already financially strapped from having to pay the > > almost $3000 for the first band (we have since borrowed money from > his > > mom and my dad). Does anybody have any advice on how we should > appeal > > this and what any of you who have had to appeal have done to be > > successful. I don't want to comprimise my son's progress, but if > the > > insurance doesn't pay anything, a second band is out of the > question. > > Looking for any help and/or advice. Thanks.> >>

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[Guest guest]

, I too have a son (ironically, named Spencer) who is going for his first appointment to obtain a DOC band for his plagiocephaly. UHC is my health insurance carrier as well and, although I am reaching out to my HR, I anticipate that they will deny coverage. Could you also send your successful appeal to me as well, so I can get started as soon as they deny. Thanks very much. Wayne Kaufmanlka_236 <lka_236@...> wrote: Email me and I

will send you a copy of my succesful UHC appeal. lka_236 Lisa> >> > Hi. I am new to this group and happy to have found you. It's nice > to > > know there are others out there with our same plight. My son has > been > > wearing his band now for almost 14 weeks. There are little if any > more > > adjustments that can be made to this one and our neuro says he may > need > > a second one. We submitted the claim for the first one to two > > insurance companies in the hope that between them we would get the > > whole thing covered. (Both my husband and I are carrying insurance > > through our jobs...CIGNA and UHC). This alone is

costing us extra > > money but we are doing it b/c our son has multiple health issues. > > Anyway, both companies have denied the claim. My husband and I are > > beside ourselves. Not that there isn't anything we wouldn't do for > our > > son, but we are already financially strapped from having to pay the > > almost $3000 for the first band (we have since borrowed money from > his > > mom and my dad). Does anybody have any advice on how we should > appeal > > this and what any of you who have had to appeal have done to be > > successful. I don't want to comprimise my son's progress, but if > the > > insurance doesn't pay anything, a second band is out of the > question. > > Looking for any help and/or advice. Thanks.> >>

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