Insurance DENIAL-Any ADVICE?

[Guest guest]

Hi Everyone:

My son went CT for a DOC Band consultation. They said he has 13mm of

assymetry. My insurance company, Cigna PPO, said they do not cover

bands unless they are used post operatively. Has anyone encountered

this? I am prepared to appeal since I cannot afford the out-of-pocket

expense even with the $300 discount. I contacted my son's doctor to get

a letter of medical necessity. Does anyone have any advice or

information that might help me in my appeal? Thank you!

[Guest guest]

Yes -- I fought CIGNA, they gave a similar reason (and two others), and we did win. Actually my argument had to do with the fact that his headshape looked exactly like a child who had sagittal craniosynostosis (long and narrow- scaphocephalic), only he didn't have a fused surture and didn't need surgery. If he did have it, he would have had to get the surgery, and would have gotten a molding device. His case was pretty severe (he couldn't lay on his back without his chin being forced to his chest because of how big the back of his head was). So, my argument -- in part, was"Why is it that my child, who was originally suspected to have craniosynostosis because of the abnormal shape of his skull, be denied the very corrective treatment that would be used if he did have it?" Then I went into discussion of what banding was, how it was a non-invasive treatment, and how not correcting the issue may cause more problems i

n the future.There are tons of wonderful letters in the files section, as well as insurance help.Feel free to contact me if you have any questions.mom to Quinn, born 11/99, DOCband graduate 10/00>------- Original Message ------->From : Tonya[mailto:t.b.lewis@...]>Sent : 2/8/2008 6:13:22 PM>To : Plagiocephaly >Cc : >Subject : RE: Insurance DENIAL-Any ADVICE?>>Hi Everyone:My son went CT for a DOC Band consultation. They said he has 13mm of assymetry. My insurance company, Cigna PPO, said they do not cover bands unless they are used post operatively. Has anyone encountered this? I am prepared to appeal since I cannot afford the out-of-pocket expense even with the $300 discount. I contacted my son's doctor to get a letter of medical ne

cessity. Does anyone have any advice or information that might help me in my appeal? Thank you!For more plagio info

[Guest guest]

Have your doctor write a prescription for the DOC Band. My insurance required it for 's helmet.

Insurance DENIAL-Any ADVICE?

Hi Everyone:My son went CT for a DOC Band consultation. They said he has 13mm of assymetry. My insurance company, Cigna PPO, said they do not cover bands unless they are used post operatively. Has anyone encountered this? I am prepared to appeal since I cannot afford the out-of-pocket expense even with the $300 discount. I contacted my son's doctor to get a letter of medical necessity. Does anyone have any advice or information that might help me in my appeal? Thank you!

[Guest guest]

I was on and when you type in words it has a drop down and helps you find what are looking for quicker, any way I found the website below of an attorney that has a child with plagio and he wants to help people with insurance coverage. I don't know if he charges, but you could ask him some questions to find out. Hope this helps.

http://plagiocoach.com/

RE: Insurance DENIAL-Any ADVICE?

Yes -- I fought CIGNA, they gave a similar reason (and two others), and we did win. Actually my argument had to do with the fact that his headshape looked exactly like a child who had sagittal craniosynostosis (long and narrow- scaphocephalic) , only he didn't have a fused surture and didn't need surgery. If he did have it, he would have had to get the surgery, and would have gotten a molding device. His case was pretty severe (he couldn't lay on his back without his chin being forced to his chest because of how big the back of his head was). So, my argument -- in part, was"Why is it that my child, who was originally suspected to have craniosynostosis because of the abnormal shape of his skull, be denied the very corrective treatment that would be used if he did have it?" Then I went into discussion of what banding was, how it was a non-invasive treatment, and how not correcting the issue may cause more problems

i n the future.There are tons of wonderful letters in the files section, as well as insurance help.Feel free to contact me if you have any questions.mom to Quinn, born 11/99, DOCband graduate 10/00>------- Original Message ------->From : Tonya[mailto: t.b.lewis@ sbcglobal. net]>Sent : 2/8/2008 6:13:22 PM>To : Plagiocephaly>Cc : >Subject : RE: Insurance DENIAL-Any ADVICE?>>Hi Everyone:My son went CT for a DOC Band consultation. They said he has 13mm of assymetry. My insurance company, Cigna PPO, said they do not cover bands unless they are used post operatively. Has anyone encountered this? I am prepared to appeal since I cannot afford the out-of-pocket expense even with the $300 discount. I contacted my son's doctor to

get a letter of medical ne cessity. Does anyone have any advice or information that might help me in my appeal? Thank you!For more plagio info, go to www.plagiocephaly. org/support