Re: 2nd Denial

[Guest guest]

>

> 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!

>

You can go to HR department of your employer and ask why your policy

excludes orthotic devices. In turn, they can contact United Health

and maybe help override their decision. Right now your policy does

not cover any type of bracing that changes the shape of the body in

any way (exactly what you want the helmet to do). This does not

only apply to a molding helmet but any orthotic device, i.e braces

for feet, scoliosis, etc. Typically, all of these braces are over a

thousand dollars.

[Guest guest]

I got approved right away for NY empire blue cross and blue shield united health care. I do not understand why they are not approving. My son was 15 mm off and went to a neurologist before cranial for a script. We then went to cranial and they submitted something for pre approval. We then went ahead with the band and got reinbursed 2400 dollars of the 3000 just this week. We started the process in October. But, the letter I got from them in November said we were pre approved. I guess this helped my case. I bet it just matters what person is reviewing the case and who is feeling nice that day. What a shame! I hope you can collect as others have. sharon_bledsoe <sharon_bledsoe@...> wrote: >> 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!>You can go to HR department of your employer and ask why your policy excludes orthotic devices. In

turn, they can contact United Health and maybe help override their decision. Right now your policy does not cover any type of bracing that changes the shape of the body in any way (exactly what you want the helmet to do). This does not only apply to a molding helmet but any orthotic device, i.e braces for feet, scoliosis, etc. Typically, all of these braces are over a thousand dollars.

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