Re: Re: New to DOC band and fighting United healtcare of TX

[Guest guest]

UHC needed three conditions met:

- a referral that the helmet was medically necessary

- child must be 3 months of age

- repo must have been tried for at least 60 days (went by first time it was

acknowldged at Dr's office)

My ortho gave me the " procedure code " and I called UHC to verify whether it was

covered or not - and it was. If your plan covers it, I think the above

conditions standardly apply for UHC. The copay / co-insurance and deductibles

will vary from plan to plan though.

If UHC tells you the procedure code is covered, then most likely it was

submitted incorrectly for approval. If UHC tells you it's not covered, then you

may want to look further into the procedure code to make sure you were given the

correct one.

Hope that helps!

Michele

Delaney - 4 months - week 2 in DOC Band!

---- mwschizer <mwschizer@...> wrote:

> We just were denied coverage by United Health Care in New York. Can

> you tell me what you said; what info you included in your successful

> appeal?

>

> Thanks, Meredith

>

> > > Hi there!

> > >

> > > I am new to this group, but have been reading your posts everyday,

> > > since I found the group. My twin son was diagnosed with

> > > Plagiocephaly (24mm cranial vault assymetry). I've always knew there

> > > was something wrong with his head, forehead, etc, etc, etc, but at

> > > least 3 pediatricians told me that it would correct itself..

> > >

> > > Anyways, I lost two whole weeks waiting for the pre-determination

> > > from UHC, at the beginning they told me many times that there was no

> > > exclusion or literature about the DOC BAND.. (and after 10 days I got

> > > the letter that denied the coverage because " orthotic appliances that

> > > straighten or re-shape a body part " are excluded.

> > >

> > > Funny that they did not find that the doc band should be covered

> > > under Medical Durable Equipment!!!!

> > >

> > > Anyways.. I banded my little one two weeks ago (today he is 7 months

> > > old), and there was a huge improvement even after only one week -

> > > (tomorow is my 2nd week appt. so I'll let you know how it goes).

> > >

> > > What I need to know, and hopefully some of you will be able to help,

> > > is if there is a data base of people that have encounter this

> > > exclusion with UHC in TX and has yet received coverage.

> > >

> > > I am looking for those lucky ones who can share their story and don't

> > > mind if I use their cases to illustrate the lack of consistency

> > > within UHC; this will help not only my case, but many other's that

> > > are in the same boat.

> > >

> > > Thanks a lot for your help!!

> > >

> >

>

>