Anyone w/ Brachy do State Hearing?

[Guest guest]

Hello all,

We appealed our 1st denial letter for coverage on our Starband. It was recently

denied even with the most awesome appeal letter...

Since Cash has Brachy there denial reason was " baby was diagnosed with

Brachycephaly:diagonal measurements are symmetrical "

So.....has anyone taken it to State with Brachy? I just want to have some imput

if its worth it or not. Please help, your comments are greatly appreciated.

Season Bron

Mom to Cash Banded 03/09

[Guest guest]

Hello Season,

I'm not sure what you mean about a state hearing...is State your insurance

carrier and you're trying to see if anyone has taken the next step (a hearing)

in the denial process? I don't have any advice on that, and have not looked at

all of the insurance pages here, so I may be stating the obvious, but my

insurance company has a " Medical Policies " section on their website which

includes various guidelines on coverage issues for specific treatments and

conditions.

There is a medical policy on when, in the insurer's opinion, DOC band orthotics

are a " medical necessity " and thus covered. That medical policy, for example,

requires one of three types of cranial asymmetry based on anthropometric

measurements. It never mentions brachy or cephalic index...but it does not

specifically exclude them either.

Essentially, that type of information is a good starting point for information

to use in appealing your denial, if your insurer has such a policy. Also, look

at your health insurance policy, because usually (sometime during the appeal

process) you'll have the right to obtain any internal guidelines and procedures

used by the company for coverage determinations, so be sure to get that

information if you haven't already.

I hope this is at least a little helpful and wish you the best! I may be right

behind you in this process with my insurance company, so I am also really

interested in what others have to say on the coverage issue for brachy babies

with little to no asymmetry.

Please update us as you are able.

Best,

Arden

>

> Hello all,

>

> We appealed our 1st denial letter for coverage on our Starband. It was

recently denied even with the most awesome appeal letter...

> Since Cash has Brachy there denial reason was " baby was diagnosed with

Brachycephaly:diagonal measurements are symmetrical "

> So.....has anyone taken it to State with Brachy? I just want to have some

imput if its worth it or not. Please help, your comments are greatly

appreciated.

>

> Season Bron

> Mom to Cash Banded 03/09

>