RE: Re: 2nd Denial

[Guest guest]

's right, if it's an exclusion in the policy then you generally can't override it -- my point was if they denied for one thing (perhaps saying it was a cosmetic issue, for example), then they cannot change the reason for the denial the second time. Many times insurance companies site 2 or more reasons in order to cover themselves. Ours happened to use 3 reasons. For example one reason was for "out of network" - but I proved that the company we used that was out of network was the best possible solution (at the time) to fix our son's head shape.However, my initial point was that it is against most state regulations to change the reason for denial, and if they did that, even if it does happen to be an exclusion in your particular policy, then you may, depending on your state's regulations, have a case to appeal again because they should have presented this information the first time.>------- Original Message ------->From : lka_236[mailto:lka_236@...]>Sent : 2/15/2008 9:33:00 PM>To : Plagiocephaly >Cc : >Subject : RE: Re: 2nd Denial>>Does your specific policy exclude orthotic devices? If so, then I really don't think (no matter how many appeals) that you'd win. We have UHC and were reimbursed 80% (as we thought we'd get from our policy). I agree with you that it is obvious that the band is medically necessary; however, I think the problem is that many insurance companies (along with doctors) think that this is a cosmetic issue and they don't view it as medically necessary. I'm not sure if you should appeal again or not. What was the reason for the first denial? &g

t;> > Did they change the reason for denial? > If so, contact your State Insurance Agency./insurance commissioner and ask them if this is allowed in your state. Generally insurance companies have to stand by the first denial and can't suddenly change if information is given to refute the reason for the 1st denial. This may or may not be the case in your state, though. > > If they did not change the reason, you can still call your State Insurance Angency and ask questions -- they may be able to help direct you to what steps to take next. Do you have any more appeals left? > > National Insurance Commissioners http://www.naic.org/ > > > Mom to Quinn, born 11/99, DOCband grad 10/00 for scaphocephalic head shape> > >------- Original Message -------> >From : White Mackey[ mailto:nikki_chica22@...] > >Sent : 2/15/2008 6:06:38 PM> >To : Plagiocephaly > >Cc : > >Subject : RE: 2nd Denial> >> >Help! We just got our second denial from UHC, based on orthotic > appliances are excluded. Should I appeal again? I had an 8 page > letter stating evidence, letter of medical necessity from the doctors, > evidence to support it was necessary. HOW MUCH MORE OBVIOUS CAN IT > BE??? Doesn't this completely go against some law somewhere, when > insurance companies refuse to pay for treatment which is medically > necessary? Help!> > > > For more plagio info