INSURANCE - LEVEL II HEARING

[Guest guest]

Dear Group Members,

First off, thanks in advance for

reading our note. I know that at times we can get 40-50 plagio messages

per day when the chatter gets busy!

We have a Level II insurance

review coming up later this month, as we continue to fight for reimbursement

for our two DOC Bands that were successful in treating our son Samson’s

brachycephaly. Has anyone else in this group had success when taking it

this far? We are tempted to get an attorney to help us on the phone call

with $6,600 in potential reimbursements in the mix. The rub is that our

insurance company (Aetna) pays for the bands in full so long as treatment

starts at 12 months of age or younger. When we adopted Samson from China,

he returned home at the ripe old age of 14 months. DOC Bands went from

fully covered at 12 months to “experimental and investigational” at

14 months. And the results are in the books – treatment already

worked.

After all of this time and

effort with our insurance appeal, we don’t want to mess it up now!

Any helpful suggestions?

Thanks, &

Duval

[Guest guest]

Hey Chris! I'm wishing you and the best of luck with this. Sadly my insurance didn't cover of the doc band we go to Arizona for. I had to get a loan and I'm sure I will have to do the same If I need a second band. I work for the insurance company I have and I know in my own case, its gonna be denied. But I think you have a good chance as they at least do over some coverage for the band. My ins says its investigational. I'm keeping my fingers crossed for you guys! Samsons pic is in the waitng room at cranial tech for the safari theme. He's so darn cute!!Sent via BlackBerry from T-MobileFrom: "Duval" Date: Tue, 10 Mar 2009 17:20:41 -0700<Plagiocephaly >Subject: INSURANCE - LEVEL II HEARING Dear Group Members, First off, thanks in advance for reading our note. I know that at times we can get 40-50 plagio messages per day when the chatter gets busy! We have a Level II insurance review coming up later this month, as we continue to fight for reimbursement for our two DOC Bands that were successful in treating our son Samson’s brachycephaly. Has anyone else in this group had success when taking it this far? We are tempted to get an attorney to help us on the phone call with $6,600 in potential reimbursements in the mix. The rub is that our insurance company (Aetna) pays for the bands in full so long as treatment starts at 12 months of age or younger. When we adopted Samson from China, he returned home at the ripe old age of 14 months. DOC Bands went from fully covered at 12 months to “experimental and investigational” at 14 months. And the results are in the books – treatment already worked. After all of this time and effort with our insurance appeal, we don’t want to mess it up now! Any helpful suggestions? Thanks, & Duval

[Guest guest]

Thanks Toni! We sort of had to take out a loan for our

bands too – CREDIT CARD. I didn’t know that they had Samson’s

picture up at Cranial Tech! That’s cool! When are you here in

Arizona next?

With the insurance stuff, we are trying to argue that their age

cut off at 12 months for repositioning bands should not be the test in our

case, as his actual physical developmental age was much less. He was only

16 lbs and tiny at 14 months when we adopted him! He grew like a weed

like we expected he would with better care and nutrition, and the band worked

as he had the skull growth we needed.

I guess the big deal to me is, it already worked – so how

can they deny coverage just by saying he was too old and it was experimental

treatment? Just seems ridiculous to me. But if you have any

pointers on what we might concentrate on during this insurance review, I would

be very grateful.

Thanks and I hope that your little man is hanging in

there! says that he the cutest kid ever. One day he will appreciate

how much you have done for him with all this. Crazy when you think of it,

but hey we want the best for our children, right? Talk with you later -

Chris

From:

Plagiocephaly [mailto:Plagiocephaly ] On

Behalf Of mommy2jaylina@...

Sent: Tuesday, March 10, 2009 7:15 PM

Plagiocephaly

Subject: Re: INSURANCE - LEVEL II HEARING

Hey Chris! I'm wishing you and the best of luck with this. Sadly my

insurance didn't cover of the doc band we go to Arizona for. I had to get a

loan and I'm sure I will have to do the same If I need a second band. I work

for the insurance company I have and I know in my own case, its gonna be

denied. But I think you have a good chance as they at least do over some

coverage for the band. My ins says its investigational. I'm keeping my fingers

crossed for you guys! Samsons pic is in the waitng room at cranial tech for the

safari theme. He's so darn cute!!

Sent via BlackBerry from T-Mobile

From: " Duval "

Date: Tue, 10 Mar 2009 17:20:41 -0700

<Plagiocephaly >

Subject: INSURANCE - LEVEL II HEARING

Dear

Group Members,

First

off, thanks in advance for reading our note. I know that at times we can

get 40-50 plagio messages per day when the chatter gets busy!

We

have a Level II insurance review coming up later this month, as we continue to

fight for reimbursement for our two DOC Bands that were successful in treating

our son Samson’s brachycephaly. Has anyone else in this group had

success when taking it this far? We are tempted to get an attorney to help

us on the phone call with $6,600 in potential reimbursements in the mix.

T he rub is that our insurance company (Aetna) pays for the bands in full so

long as treatment starts at 12 months of age or younger. When we adopted

Samson from China, he returned home at the ripe old age of 14 months. DOC

Bands went from fully covered at 12 months to “experimental and

investigational” at 14 months. And the results are in the books

– treatment already worked.

After

all of this time and effort with our insurance appeal, we don’t want to

mess it up now! Any helpful suggestions?

Thanks,

& Duval

[Guest guest]

Ill be in Arizona the 15th to 16th next. Well, honestly the big things are the medically records and the letter of medical necessity. He was a tiny guy when you got him and the final papers from CT will show just how much it did work. I'm really really hoping though that since your ins offers some coverage that they will take into consideration all factors in samsons case! Insurance makes me mad how they consider things investigational or not medically necessary! Keep me posted! I hoping my baby bug hits a growth spurt here soon. So far we've had the band 7 weeks and haven't seen any change but I'm hopeful! Going to Arizona so often drives me crazy but heck yea we will go to hell and back for our kids and do anything for them!Sent via BlackBerry from T-MobileFrom: "Duval" Date: Wed, 11 Mar 2009 07:52:43 -0700<Plagiocephaly >Subject: RE: INSURANCE - LEVEL II HEARING Thanks Toni! We sort of had to take out a loan for our bands too – CREDIT CARD. I didn’t know that they had Samson’s picture up at Cranial Tech! That’s cool! When are you here in Arizona next? With the insurance stuff, we are trying to argue that their age cut off at 12 months for repositioning bands should not be the test in our case, as his actual physical developmental age was much less. He was only 16 lbs and tiny at 14 months when we adopted him! He grew like a weed like we expected he would with better care and nutrition, and the band worked as he had the skull growth we needed. I guess the big deal to me is, it already worked – so how can they deny coverage just by saying he was too old and it was experimental treatment? Just seems ridiculous to me. But if you have any pointers on what we might concentrate on during this insurance review, I would be very grateful. Thanks and I hope that your little man is hanging in there! says that he the cutest kid ever. One day he will appreciate how much you have done for him with all this. Crazy when you think of it, but hey we want the best for our children, right? Talk with you later - From: Plagiocephaly [mailto:Plagiocephaly ] On Behalf Of mommy2jaylinaaolSent: Tuesday, March 10, 2009 7:15 PMPlagiocephaly Subject: Re: INSURANCE - LEVEL II HEARING Hey Chris! I'm wishing you and the best of luck with this. Sadly my insurance didn't cover of the doc band we go to Arizona for. I had to get a loan and I'm sure I will have to do the same If I need a second band. I work for the insurance company I have and I know in my own case, its gonna be denied. But I think you have a good chance as they at least do over some coverage for the band. My ins says its investigational. I'm keeping my fingers crossed for you guys! Samsons pic is in the waitng room at cranial tech for the safari theme. He's so darn cute!! Sent via BlackBerry from T-Mobile From: " Duval " Date: Tue, 10 Mar 2009 17:20:41 -0700<Plagiocephaly >Subject: INSURANCE - LEVEL II HEARING Dear Group Members, First off, thanks in advance for reading our note. I know that at times we can get 40-50 plagio messages per day when the chatter gets busy! We have a Level II insurance review coming up later this month, as we continue to fight for reimbursement for our two DOC Bands that were successful in treating our son Samson’s brachycephaly. Has anyone else in this group had success when taking it this far? We are tempted to get an attorney to help us on the phone call with $6,600 in potential reimbursements in the mix. T he rub is that our insurance company (Aetna) pays for the bands in full so long as treatment starts at 12 months of age or younger. When we adopted Samson from China, he returned home at the ripe old age of 14 months. DOC Bands went from fully covered at 12 months to “experimental and investigational” at 14 months. And the results are in the books – treatment already worked. After all of this time and effort with our insurance appeal, we don’t want to mess it up now! Any helpful suggestions? Thanks, & Duval