Re: Help!!! United Healthcare Denial

[Guest guest]

Wow. I haven't been on the board in a while and I just wanted to

check in to see what's been going on. I still can't believe the

number of people being denied coverage for this

treatment...unbelievable!!!

A few words of advice from my personal experience...I wouldn't wait

until I hear from the insurance co. to start treatment. They can

take months to send an approval/denial and that's precious treatment

time. I would definitely send in a claim/pre-approval for the

service before the actual service date so that you are " following

procedure " . But once that's done and you are certain they have

received it and are processing it, I would proceed with treatment.

That's what we did with UHC.

Also, when sending in your paperwork, make sure you cite the

procedure and service code(s) several times throughout your

paperwork. UHC claimed on multiple occasions that we didn't include

this info and that nothing could be processed until it was received

(even though we had it listed twice in our claim and appeal!).

One thing I would definitely consider when writing an appeal is that

there are LOTS and LOTS of claims for helmets from these insurance

companies that have been approved. Unless you have a specific

exclusion for this service (which I hear are difficult to get

around), there is no reason they can deny these claims other than

just to see if they can get away with it. Site other successful

cases in your appeal.

You can look at my appeal letter and use it if you want...it's posted

in the files section. It's pretty much a compilation of a bunch of

other letters I found on this site, with a bunch of research info

added in. My final appeal was 250 pages (including full research

articles). I don't think they have to be this extensive, I just

didn't want there to be any loopholes!

The research articles are really hard to find if you don't have

access to a university library or research library. Thankfully, my

husband was a student at OU at the time of our research and I was

able to get the articles there. I would be more than happy to share

them with you...just email me your mailing address and I'll get a

copy out to you.

Good luck to you all...I'm saying a little cheer for you guys!!!

Lori

Mom to , 16 months

DOC Band grad July '07

> > >

> > > We received a denial from United Healthcare. It

> indicates " orthotic

> > > appliances that straighten or re-shape a body (including some

> sorts

> > of

> > > braces) " are excluded from coverage.

> > >

> > > Has any one had s uccess in the appeals process with United

> Healthcare

> > > for this specific denial? Any help you could offer would be

most

> > > appreciated.

> > >

> > > Thanks,

> > >

> > > Jeff

> > > Father to

> > > 8 months old

> > >

> >

>

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