RE: Aetna Insurance - Denied!!

March 21, 2009

Hi

How many times did they deny you before you had a hearing? We have Aetna

and have been denied 2 times and are still fighting to get payment. If you have

any advice, I would appreciate it!! Good Luck with your son (Sampson I

believe)- enjoy him!!!!!!!!

Thanks,

Mom to McKenna

> From: Duval <chrisduval@...>

> Subject: Aetna Insurance - APPROVED!

> Plagiocephaly

> Date: Saturday, March 21, 2009, 2:54 PM

> We were diligent in following through on the appeal process,

> and had a Level

> II hearing with the panel scheduled for this coming week.

> It appears that

> they had someone reasonable review our case again before

> the review, for

> which we felt VERY prepared, and DOC Band 1 and DOC Band 2

> were both

> approved for full reimbursement! Our plan pays 100% of all

> approved durable

> medical devices, so it appears as if we have $6,600 coming

> back that we

> originally paid for out of pocket!

>

> I write this to the group because at several times during

> the appeal

> process, I truly thought that I was wasting my time and

> that we were stuck.

> If your insurance company has denied coverage for your

> child's DOC Band or

> similar device, stick with it --- because if you can make a

> sensible

> argument and lay out logical reasons as to why treatment

> was necessary for

> your child's health and well-being, and possible

> complications that may well

> arise had treatment NOT occurred, then there is a good

> chance that they will

> do what they feel is the right thing.

>

> Of course I don't think that we would have been

> reimbursed for EITHER of our

> DOC Bands had they not WORKED so well as they did

> (especially for an older

> child beginning treatment at 14 months). We continue to

> highly recommend

> Cranial Technologies (we were cared for at their Phoenix

> offices) and will

> forever be thankful to them for helping our little Samson!

>

> I will drop this message board a note when we actually have

> the

> reimbursement check in hand. Part of me still does not

> believe it! As

> companies like Cranial Tech continue to document results

> and make

> improvements in their treatment plans, it will be much

> easier for parents in

> the future to avoid many of these insurance headaches that

> many of us have

> had to endure with our children. Have a great weekend and

> long-live the DOC

> Band!

>

> Duval, Dada of Samson the Destroyer of All Things Not

> Bolted Down!

March 22, 2009

Hi ,

We have learned a lot about Aetna and their review process. Feel

free to email me directly at chrisduval@...

and I will be more than happy to see if I can help! Aetna has so many

different plans. In our case, Cranial Tech informed us that we had little to

no shot at getting pre-approval for Samson’s first DOC Band. So instead of

wasting time, as he was already 14-15 months old, we just did it and figured we

would go back to the insurance company with actual results. After success with

the first band, and confirmation from our pediatrician that his plates had not

yet completely fused, we went for a second band and saw similar improvements.

Then we had Cranial Tech put in the claims for both bands. They

were both denied instantly. We then put some information together for an

appeal, and sent it in to Aetna directly to their claims department (faxed in

everything). This first appeal was also instantly denied. We know this

because a letter was sent to us on the day the received the information,

leading us to think that maybe no one even read the materials we sent at all?

Then we did what is referred to as a Level II appeal. We received a letter

that for us was relatively intimidating. It scheduled a time for the Level II

review, and gave detailed instructions for the whole process. We sent in the

information requested (and then some), and we were contacted before the

scheduled hearing date with news that both band had been approved for full

reimbursement!

So as I said, contact me directly if you would like further

detail. There were about 100 phone calls made to Aetna throughout this whole

process while we felt our way through the system. It can be very frustrating,

but business is business and the truth is that most people you will speak with

at Aetna are clearly NOT incented to make sure that claims are paid. More the

case is that they will concentrate on anything they can think of that will

result in a denial of a claim. In our case it was Samson’s older age.

If we can help you, we will sure try! Remember that there is a

clock running on all of this stuff, so don’t wait too long before action!

Chris

From: Plagiocephaly

[mailto:Plagiocephaly ] On Behalf Of Roper

Sent: Saturday, March 21, 2009 5:39 PM

Plagiocephaly

Subject: Re: Aetna Insurance - Denied!!

Hi

How many times did they deny you before you had a hearing? We have Aetna and

have been denied 2 times and are still fighting to get payment. If you have any

advice, I would appreciate it!! Good Luck with your son (Sampson I believe)-

enjoy him!!!!!!!!