New to group, question about appealing insurance denial

[Guest guest]

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'm so sorry to hear that you've had to fight for this, especially since your son has gone through so many other things. If he was in ICU for any amount of time, and time holding him was limited, please consider using this information in your appeal -- this fact should actually be in your doctor's letter of medical necessity if it was part of the reason that he has plagiocephaly.In 2000 we did get CIGNA to pay upon appeal. But each plan is different -- and since 2000 many insurance companies started to write disclaimers for banding, or restrictions, etc. The reason of denial should be the first place to start -- if either policy states they don't cover banding at all -- well even UHC has covered some on appeal (and I know CIGNA has). So the first place to start is to know each policy's information. If the reason is "experimental in nature" -- banding/helmets have been around for many years, and most are FDA approved (make sure your provider is before using this argument). I could go on but there are many awesome letters in the files section that you can read and get information from. Additionally, in 2000 I was asked to put a short Insurance FAQ together, which can be fournd at http://www.plagiosupport.org/insurance.htm -- though this has not been updated since companies started to write exclusions, etc. Please understand some things might have changed since then.Good luck.mom to Quinn, born 11/99, DOCband graduate for scaphocephalic (long/narrow) head shape 10/00>------- Original Message ------->From : newmom328[mailto:NAV111@...]>Sent : 1/27/2008 5:46:58 PM>To : Plagiocephaly >Cc : >Subject : RE: [Plagio

] New to group, question about appealing insurance denial>>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 borro

wed 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.For more plagio info