Guest guest Posted October 22, 2009 Report Share Posted October 22, 2009 I received a letter from United Healthcare today saying Avery's helmet was denied. We decided to pay outright and then submit to insurance so it would not delay her progress. My question is that did anyone see any issue with telling your insurance company you already had the helmet? I would hate for them to deny it because we already paid for it. I see all the letters on the file for the appeals process. A lot of the links in their letters are no longer working. If anyone has been successful lately with their appeal process, can you please let me know? I would like to have as much support as I can. Thank you, Avery StarBand 9/27/09 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 22, 2009 Report Share Posted October 22, 2009 , We also were denied by UHC - three times (started appeal process in June 2009 and our last appeal was denied last month). Even tried to get our elected officials to help (one of which tried) but no luck with any of our appeals. My understanding is that UHC is one of the worst for cranial band coverage. We had a DOC Band, but I wouldn't think the brand would make a difference. In doing some research, there were families who got coverage and/or won appeals to UHC, but it all depends on your policy. Check your Certificate of Coverage. If there is a specific exclusion for cranial banding (and it will be listed under " Exclusions " ) they told us they would not make an exception. Ever. We also learned that it is not often offered as a covered item in policies that UHC writes. So, if you have a UHC policy in which there is coverage, you are very fortunate. Now, if there isn't a specific exclusion, you might win an appeal based on medical necessity or something else. In that case, I'd put together a thorough appeal letter/packet with plenty of documentation from the ped who wrote the prescription and any other medical notes you have. I'd also reference and include the medical studies on untreated plagio...basically whatever you can find to support your case. When I put together our second appeal, I knew there was little chance of winning based on what we knew about our policy and UHC, but I did it anyway -- just in case. You never know unless you try. Hope that helps. Jill Cade's mom Texas > > I received a letter from United Healthcare today saying Avery's helmet was denied. We decided to pay outright and then submit to insurance so it would not delay her progress. My question is that did anyone see any issue with telling your insurance company you already had the helmet? I would hate for them to deny it because we already paid for it. > > I see all the letters on the file for the appeals process. A lot of the links in their letters are no longer working. If anyone has been successful lately with their appeal process, can you please let me know? I would like to have as much support as I can. > > Thank you, > > > Avery > StarBand 9/27/09 > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 22, 2009 Report Share Posted October 22, 2009 , I am currently going through the same process. We paid out of pocket for the same reason, I did not want to spend months fighting with the insurance company while my daughter's treatment was delayed. I've been told by multiple sources that having already paid for the device will have no impact on the insurance company's decision. I will continue to update on the board as I get further in my appeal process. I wish you well! Jo Anne Mom to (7 Months) Doc Band (October 9th) Dallas, TX > > I received a letter from United Healthcare today saying Avery's helmet was denied. We decided to pay outright and then submit to insurance so it would not delay her progress. My question is that did anyone see any issue with telling your insurance company you already had the helmet? I would hate for them to deny it because we already paid for it. > > I see all the letters on the file for the appeals process. A lot of the links in their letters are no longer working. If anyone has been successful lately with their appeal process, can you please let me know? I would like to have as much support as I can. > > Thank you, > > > Avery > StarBand 9/27/09 > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 22, 2009 Report Share Posted October 22, 2009 Our son's band was also denied by UHC - but we are hoping to appeal. I'll let you know if we have any success, we're only just now starting the process. > > I received a letter from United Healthcare today saying Avery's helmet was denied. We decided to pay outright and then submit to insurance so it would not delay her progress. My question is that did anyone see any issue with telling your insurance company you already had the helmet? I would hate for them to deny it because we already paid for it. > > I see all the letters on the file for the appeals process. A lot of the links in their letters are no longer working. If anyone has been successful lately with their appeal process, can you please let me know? I would like to have as much support as I can. > > Thank you, > > > Avery > StarBand 9/27/09 > Quote Link to comment Share on other sites More sharing options...
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