Re: Aetna Insurance - APPROVED!

[Guest guest]

It is a wonderful news and good job! Did you actually hire an attorney?From: Duval <chrisduval@...>Plagiocephaly Sent: Saturday, March 21, 2009 10:54:12 AMSubject: Aetna Insurance - APPROVED!

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!

[Guest guest]

No attorney.  Just scraped together everything I could on what

MIGHT have happened with Samson had he NOT been successfully banded.  His

brachycephaly was quite severe.  They say that a picture is worth a thousand

words, and I think that in our case the before and after clinical photos really

struck home.  I wish that I could tell you in the end what the deciding factors

were for Aetna’s upper level review people and medical advisors that looked at

our case, but I will just never know for sure!

It was quite a lesson when dealing with insurance companies, I

will give you that.  In the end, Aetna did the right thing and they have been

great in taking care of all of Samson’s other healthcare needs.

From:

Plagiocephaly [mailto:Plagiocephaly ] On

Behalf Of ZK

Sent: Saturday, March 21, 2009 11:35 AM

Plagiocephaly

Subject: Re: Aetna Insurance - APPROVED!

It is a wonderful news and good job! Did you actually hire

an attorney?

From: Duval <chrisduval@...>

Plagiocephaly

Sent: Saturday, March 21, 2009 10:54:12 AM

Subject: Aetna Insurance - APPROVED!

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!

Chris

Duval, Dada of Samson the Destroyer of All Things Not Bolted Down!

[Guest guest]

Oh my gosh YAY!!!!!! I'm so happy for you and !!!!! That's great!!!!Sent via BlackBerry from T-MobileFrom: "Duval" Date: Sat, 21 Mar 2009 18:42:28 -0700<Plagiocephaly >Subject: RE: Aetna Insurance - APPROVED! No attorney.  Just scraped together everything I could on what MIGHT have happened with Samson had he NOT been successfully banded.  His brachycephaly was quite severe.  They say that a picture is worth a thousand words, and I think that in our case the before and after clinical photos really struck home.  I wish that I could tell you in the end what the deciding factors were for Aetna’s upper level review people and medical advisors that looked at our case, but I will just never know for sure! It was quite a lesson when dealing with insurance companies, I will give you that.  In the end, Aetna did the right thing and they have been great in taking care of all of Samson’s other healthcare needs. From: Plagiocephaly [mailto:Plagiocephaly ] On Behalf Of ZKSent: Saturday, March 21, 2009 11:35 AMPlagiocephaly Subject: Re: Aetna Insurance - APPROVED! It is a wonderful news and good job! Did you actually hire an attorney? From: Duval <chrisduvalqwest (DOT) net>Plagiocephaly Sent: Saturday, March 21, 2009 10:54:12 AMSubject: Aetna Insurance - APPROVED! 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!

[Guest guest]

That is Fabulous!!!!!!!!!!!

I wonder if you wouldn't mind posting a copy of the letter in the files section with all the personal info removed for future families that will be fighting the same fight?

It could be so helpful!!!

Thanks and Congrats!!!!!!!

Jen

Mom to Luli - 3 yrs old

Torticollis, Plagio, Syringomyelia

Aetna Insurance - APPROVED!

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-li

ve the DOC Band!

Duval, Dada of Samson the Destroyer of All Things Not Bolted Down!

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