Guest guest Posted February 25, 2008 Report Share Posted February 25, 2008 Hi everyone. I'm in the process of appealing UHC. I've called UHC and they have sent my claim back for a manual review to be done. I guess I have a couple of questions. 1) For those of you that have appealed UHC- has anyone got a denial reason of Durable equitment not covered? If so how did you go about appealing it? 2) When I got my original Explanation of Benefits back from UHC-they stated: "In order for this service to be considered for coverage, you must submit medical records that demonstrate a physiological functional impairment along with a requirmetns indicated in your benefits plan language." After my claim was sent for a manual review, they sent me a letter stating : "The plan does not cover durable medical equitment that changes the shape of a body part. This is a plan exlusion." I guess I'm confused by the fact that they original y denied it for one reason, and then denied it for a different reason. (Or am I reading things wrong?) Any help would be appreciated. Lorie Mom to Spencer and Alizabeth 10months Spener- DOC Band Grad- 9/07-12/07 Glendale, AZ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2008 Report Share Posted February 25, 2008 From the way you explained it, it sounds like that they first wanted supporting documentation, and were not necessarily denying it. You have to look at the fine print of your plan. An exclusion is an exclusion. However I am not all knowing about insurance companies so someone else might be able to help you better Katrin Mom of Elijah 08/21/07 Banded 02/21/08 United Health Care denial Hi everyone. I'm in the process of appealing UHC. I've called UHC and they have sent my claim back for a manual review to be done. I guess I have a couple of questions. 1) For those of you that have appealed UHC- has anyone got a denial reason of Durable equitment not covered? If so how did you go about appealing it? 2) When I got my original Explanation of Benefits back from UHC-they stated: "In order for this service to be considered for coverage, you must submit medical records that demonstrate a physiological functional impairment along with a requirmetns indicated in your benefits plan language." After my claim was sent for a manual review, they sent me a letter stating : "The plan does not cover durable medical equitment that changes the shape of a body part. This is a plan exlusion." I guess I'm confused by the fact that they original y denied it for one reason, and then denied it for a different reason. (Or am I reading things wrong?) Any help would be appreciated. Lorie Mom to Spencer and Alizabeth 10months Spener- DOC Band Grad- 9/07-12/07 Glendale, AZ More new features than ever. Check out the new AOL Mail! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2008 Report Share Posted February 25, 2008 I don't have UHC and have not had to appeal (yet!-still waiting on our claim), but just from the language you included, it sounds like they are denying for basically the same reason, or at least under the same clause. The first explanation asked for medical records as to why the durable medical equipment (DME) would be needed, like they needed clarification before they would ok it. For their purposes, it sounds like they are definig DME to only include walkers, canes, crutches, wheelchairs, etc. So the second explanation then says they don't cover equipment that changes a body part. s and such don't change body parts, so they are obviously looking at the helmet as an exclusion under the DME clause. Obviously, that doesn't help you. I've read other posts that said they can't deny you for one reason, and then state a second difference reason later. But I'm not sure if yours falls into that, maybe someone else can chime in on that. My health plan specifically lists dynamic orthotic cranioplasty (DOC) devices under the durable medical equipment clause. For the group: Does anyone know if it would help to maybe provide UHC with examples of other insurance plans that include the bands under DME? Or do you think they won't care? Just a thought. Good luck on your appeal! Jake-17m (tort resolved/rt plagio/DocBand) Jordan-4 > > Hi everyone. I'm in the process of appealing UHC. I've called UHC and they have sent my claim back for a manual review to be done. I guess I have a couple of questions. 1) For those of you that have appealed UHC- has anyone got a denial reason of Durable equitment not covered? If so how did you go about appealing it? 2) When I got my original Explanation of Benefits back from UHC-they stated: " In order for this service to be considered for coverage, you must submit medical records that demonstrate a physiological functional impairment along with a requirmetns indicated in your benefits plan language. " After my claim was sent for a manual review, they sent me a letter stating : " The plan does not cover durable medical equitment that changes the shape of a body part. This is a plan exlusion. " > I guess I'm confused by the fact that they original y denied it for one reason, and then denied it for a different reason. (Or am I reading things wrong?) > Any help would be appreciated. > > Lorie > Mom to Spencer and Alizabeth 10months > Spener- DOC Band Grad- 9/07-12/07 > Glendale, AZ > Quote Link to comment Share on other sites More sharing options...
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