Re: [SPAM] Insurance denial-Please Help!

[Guest guest]

,

I am going through the same problem with UHC. Although I am still in the process of my first appeal. Did you request a copy of the scientific basis and clinical judgment that was relied upon in making the no coverage decision for the claim? This is something that they have to send you, once you request it. I'm not sure how much help it can be, but it might give you another window of opportunity to find the loop hole you need. My son's claim was denied for the same reason. When I talked with a friend of mine that is a attorney, he suggested that I request the letter from UHC that gives the scientific basis on the denial.

I would still go through with a 2nd appeal, but I would request the letter first. By the way what kind of band does your son have?

Best of luck

Lorie

Mom to Spencer and Alizabeth 10 months

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

Glendale,AZ

[sPAM] Insurance denial-Please Help!

My son is now 8 & 1/2 months old and I just receivedmy second denial letter from United Health Care, thisone in response to my first appeal letter. My appealletter was a 12 page document which includedexplanation of medical necessity, current standards ofcare in treating plagio/brachy, AMA definitions ofdeformities, disfigurement, and congenital defects,and cosmetic vs. reconstructive, extensive research oflong term effects of untreated plagio, etc. I am soupset and I don't know what else to do. I spent somuch time and energy in my first appeal letter and Ifeel like my window of opportunity is slipping by. Does anyone else have any suggestions for me? ShouldI attempt a second appeal letter? If so, what elsecan I include to convince them? The reason they gaveme for denial is plan exclusion based on the helmetbeing an orthotic appliance that straightens orre-shapes a body part. Thank you in advance for anyhelp. I am desperate. Cincinnati, OH__________________________________________________________Be a better friend, newshound, and know-it-all with Mobile. Try it now. http://mobile./;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ

[Guest guest]

I have not requested the scientific basis and clinical

judgement that they used to make their decision.

Thank you for the suggestion. I will call them today.

We have not gotten a helmet yet, but have an

appointment with Hanger tomorrow afternoon. This will

be his 2nd fitting. His first fitting was a month and

a half ago, before we knew that insurance was going to

deny the claim. I am wondering if his head has gotten

worse in the past 6 weeks. My husband and I have

decided to pay out of pocket for the helmet and

continue to fight the insurance denial. I just feel

like we can't put this off any longer.

Thanks for your help.

Mom to , 8 & 1/2 months, severe brachycephaly

Cincinnati, OH

--- Lorie Fitzgerald <lfitz_1@...> wrote:

> ,

> I am going through the same problem with UHC.

> Although I am still in the process of my first

> appeal. Did you request a copy of the scientific

> basis and clinical judgment that was relied upon in

> making the no coverage decision for the claim? This

> is something that they have to send you, once you

> request it. I'm not sure how much help it can be,

> but it might give you another window of opportunity

> to find the loop hole you need. My son's claim was

> denied for the same reason. When I talked with a

> friend of mine that is a attorney, he suggested that

> I request the letter from UHC that gives the

> scientific basis on the denial.

> I would still go through with a 2nd appeal,

> but I would request the letter first. By the way

> what kind of band does your son have?

>

> Best of luck

>

> Lorie

> Mom to Spencer and Alizabeth 10 months

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

> Glendale,AZ

> [sPAM] Insurance denial-Please

> Help!

>

>

> My son is now 8 & 1/2 months old and I just

> received

> my second denial letter from United Health Care,

> this

> one in response to my first appeal letter. My

> appeal

> letter was a 12 page document which included

> explanation of medical necessity, current

> standards of

> care in treating plagio/brachy, AMA definitions of

> deformities, disfigurement, and congenital

> defects,

> and cosmetic vs. reconstructive, extensive

> research of

> long term effects of untreated plagio, etc. I am

> so

> upset and I don't know what else to do. I spent so

> much time and energy in my first appeal letter and

> I

> feel like my window of opportunity is slipping by.

>

> Does anyone else have any suggestions for me?

> Should

> I attempt a second appeal letter? If so, what else

> can I include to convince them? The reason they

> gave

> me for denial is plan exclusion based on the

> helmet

> being an orthotic appliance that straightens or

> re-shapes a body part. Thank you in advance for

> any

> help. I am desperate.

>

>

> Cincinnati, OH

>

>

>

__________________________________________________________

> Be a better friend, newshound, and

> know-it-all with Mobile. Try it now.

>

http://mobile./;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ

>

>

>

>

>

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