Navigating Insurance Denials

August 3, 2009

Hello, I am pretty new to this board and have been following some of the threads

for a couple of weeks now. I'm hoping someone can help or at least offer some

general guidance. We have Lifewise insurance of Arizona(not a very common

insurance) and were flat out denied coverage of the doc band. Not sure what the

reasoning was, they told us at the cranial technologies office that they are

usually good about negotiating with the insurance companies but they had no

luck. They told us even if we had Blue Cross we'd have no luck either. We were

going to switch but I guess it makes no difference.

So does this mean I need to start the appeal process or is it pretty much a lost

cause? Where do I begin? We have not received a denial letter yet. I have

looked over some of the letters in the files section and it's a bit overwhelming

with all the medical data, citations etc. It sucks that we have such crummy

insurance and my husband is even a Dr! Go figure. We've already paid close to

$4,000 out of pocket for a normal non-complicated delivery and prenatal care.

We'd like to at least try to get some coverage. Especially if there is a

possibility that we'll need 2 bands. I don't understand because for everything

else, they've said they would cover 80% as long as we met our dectible of

$1,500. I don't see how this is any different for other orthotic medical

devices. Is plagiocephaly so rare that they just don't understand what it is or

how it's treated? I'm so frustrated...What does it mean to have insurance

anymore?

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