Re:United Healthcare Insurance Appeal

[Guest guest]

Jill,

We have the same unfortunate exclusion in our policy. I did

try to appeal it based on definitions. I argued that it was not a brace for

his head etc but it specifically states does not cover cranial banding. I know

it is frustrating. After the first appeal was denied I was told I could have a

hearing if I wanted to but I decided against it since it was stated in several

places in the policy. I hope you have more luck than I did. I am also happy

to send you a copy of the letter that I sent.

Best,

[Guest guest]

Me too. We are in the middle of our appeal right now. Sent it in about 5 weeks

ago. We used the sample letters 10 and 11 for othotic exclusions shown here:

http://www.cappskids.org/PlagioInsuranceHelp.htm

combined with text from a few other example letters that can be found on this

website under the Files menu and some text of our own to fight the appeal. It

is tough with this type of appeal. You have to argue why it should not be

excluded, how they should be interested in preventative procedures, that the

orthotic is used to encourage proper growth, not reshape the head, how

plagiocephaly can cause numerous health problems if left untreated, how the

AMA's policies are in direct contradiction to UHC's stated coverage and how

numerous other insurance companies insure children for the same problem. We got

supporting letters of medical recommendations from our orthotist, pediatrician

and our occupational therapist and referenced numerous research papers that

listed potential future medical problems for children with plagiocephaly.

Not sure if our appeal letter will work or not, but I am giving it our best try.

Let me know if you would like to see the letter and I can post it. It still has

our personal information in it, but I can take a few minutes to remove those

references if you need it.

best of luck,

>

> Jill,

>

> We have the same unfortunate exclusion in our policy. I did try to appeal

> it based on definitions. I argued that it was not a brace for his head etc

> but it specifically states does not cover cranial banding. I know it is

> frustrating. After the first appeal was denied I was told I could have a

> hearing if I wanted to but I decided against it since it was stated in

> several places in the policy. I hope you have more luck than I did. I am

> also happy to send you a copy of the letter that I sent.

>

> Best,

>

>

>

[Guest guest]

,

If you could post it, that would be great. Thank you for your help. We'll give

it a try. Let me know how yours turns out.

Jill

> >

> > Jill,

> >

> > We have the same unfortunate exclusion in our policy. I did try to appeal

> > it based on definitions. I argued that it was not a brace for his head etc

> > but it specifically states does not cover cranial banding. I know it is

> > frustrating. After the first appeal was denied I was told I could have a

> > hearing if I wanted to but I decided against it since it was stated in

> > several places in the policy. I hope you have more luck than I did. I am

> > also happy to send you a copy of the letter that I sent.

> >

> > Best,

> >

> >

> >

>

[Guest guest]

Hi Jill,

I just sent it to your account. Let me know when/if you got it.

So far, UHC told me that they mailed me a confirmation letter and a letter

indicating they have upheld the denial, but I have not received anything even

though they said they sent it on almost 3.5 weeks ago. They said they sent the

letter to Hanger as well, but they have received nothing either. I asked them

to resend it a week ago and fax it as well. Still have not received anything.

I originally appealled the pre-notification of service denial. I went ahead

with the helmet anyway and now that I did they want to see the claim before they

address the appeal, which is obviously backwards. They are saying that after

they receive the claim, if they deny it again, then I can appeal it again.

Makes no sense why they can't just deal with the appeal that I sent them. UHC

seems to have a pretty incompetent appeals department and the only way to get

information is by talking to the rapid resolution department. They have access

to the most information, general member services is pretty useless.

Anyway, I have not given up. I will keep pursuing this thru a 2nd appeal. I

have some family members that have offered to help if I appeal again as one of

them works full time dealing with this type of stuff so she might have some good

advice. When/if I get to that stage I will be sure to post any valuable info

on here.

Best of luck!

-

> > >

> > > Jill,

> > >

> > > We have the same unfortunate exclusion in our policy. I did try to appeal

> > > it based on definitions. I argued that it was not a brace for his head

etc

> > > but it specifically states does not cover cranial banding. I know it is

> > > frustrating. After the first appeal was denied I was told I could have a

> > > hearing if I wanted to but I decided against it since it was stated in

> > > several places in the policy. I hope you have more luck than I did. I am

> > > also happy to send you a copy of the letter that I sent.

> > >

> > > Best,

> > >

> > >

> > >

> >

>

[Guest guest]

Jill,

I never heard back from you. I sent you the appeal letter. Did you get it?

-

> > >

> > > Jill,

> > >

> > > We have the same unfortunate exclusion in our policy. I did try to appeal

> > > it based on definitions. I argued that it was not a brace for his head

etc

> > > but it specifically states does not cover cranial banding. I know it is

> > > frustrating. After the first appeal was denied I was told I could have a

> > > hearing if I wanted to but I decided against it since it was stated in

> > > several places in the policy. I hope you have more luck than I did. I am

> > > also happy to send you a copy of the letter that I sent.

> > >

> > > Best,

> > >

> > >

> > >

> >

>

[Guest guest]

,

Yes, I did get the letter. Many thanks. I am still working on our appeal. I

apologize for not getting back to you to let you know I received it. I probably

had a baby in my lap when I opened your email...and then never made it back to

reply when I was hands-free again. I find myself doing that more and more these

days. :-) Many thanks again for your help. I will let you know how ours turns

out. Any new news on your end?

Jill

> > > >

> > > > Jill,

> > > >

> > > > We have the same unfortunate exclusion in our policy. I did try to

appeal

> > > > it based on definitions. I argued that it was not a brace for his head

etc

> > > > but it specifically states does not cover cranial banding. I know it is

> > > > frustrating. After the first appeal was denied I was told I could have

a

> > > > hearing if I wanted to but I decided against it since it was stated in

> > > > several places in the policy. I hope you have more luck than I did. I

am

> > > > also happy to send you a copy of the letter that I sent.

> > > >

> > > > Best,

> > > >

> > > >

> > > >

> > >

> >

>

[Guest guest]

That's great, best of luck!

No real update on this end. I was told that they upheld the denial, but the

appeal was resubmitted when I last spoke to Rapid Resolution pending new

information they received from Hanger. It was actually information they

received weeks ago, but they do not proactively link all received paperwork.

Another lesson learned, try to have all information sent in one packet. I even

told them in my appeal packet that they would be receiving more information from

Hanger and not to review the appeal until it was received but apparently that

did no good.

Anyway, we take great comfort in knowing that our son has his helmet and is

improving quite a bit already. The money would be great but UHC's incompetence,

stubborness and lack of feedback does not give me much faith.

Oh, make sure you cc the State Insurance commissioner. I decided against it,

but was advised after the fact by some family members who work for insurance

companies that you should always cc them.

Again, good luck! I believe the more people appeal to UHC the better off

everyone will be in the long run. Hopefully, their policies will get updated

someday.

> > > > >

> > > > > Jill,

> > > > >

> > > > > We have the same unfortunate exclusion in our policy. I did try to

appeal

> > > > > it based on definitions. I argued that it was not a brace for his

head etc

> > > > > but it specifically states does not cover cranial banding. I know it

is

> > > > > frustrating. After the first appeal was denied I was told I could

have a

> > > > > hearing if I wanted to but I decided against it since it was stated in

> > > > > several places in the policy. I hope you have more luck than I did.

I am

> > > > > also happy to send you a copy of the letter that I sent.

> > > > >

> > > > > Best,

> > > > >

> > > > >

> > > > >

> > > >

> > >

> >

>