Re: Anyone With an Exclusion Gotten Insurance Coverage?

[Guest guest]

I can't answer your question directly, but I do have some information for you. We have MDIPA, which is governed by UHC. They also had an exlusion in their policy; however when we submitted the request, they responded by saying that there was an exlusion, but that they would cover a band from Hanger. It was really odd. We didn't get this information the first three times that we called about it. It was in a letter that denied coverage for the STARband. I called after getting the letter and the person on the phone had to spend a long time looking things up before confirming that this was true. Well, I ended up not wanting to wait to get the process started with Hanger because was already 14 months old and a two week difference in getting started was enough for me to go ahead and just pay out of pocket. To be honest, this makes absolutely no sense, but it was what happened for us. So, go ahead and give it a try.

, mom to , 27 months

STARbaand grad May 2009

Chiro and CST

land

Anyone With an Exclusion Gotten Insurance Coverage?

I've poured over hundreds of messages in this forum in the last few days and have seen lots of cases where people successfully appealed; however, I don't think I've seen one where anyone successfully appealed when there was an exclusion on cranial banding written into their policy. Anyone have an exclusion in their policy but was still able to get a helmet paid for by insurance? We have the United Healthcare Choice Plus plan, and the policy purchased by our Employer has an exclusion for cranial banding. It seems pretty black and white that the Insurance won't pay for this, since they specifically state that they won't, so I'm wondering if I should even delay our helmet scanning/casting to hear back about our predetermination. (If we wait to hear and are denied, we definitely won't wait to cast until hearing back about an appeals--that would be way too long. We'll just go ahead with it and plan to have to pay out of pocket with maybe an attempt at an appeal.) The UHC rep said she couldn't even tell me over the phone whether there was an exclusion in our specific policy (just that there isn't one in the Choice Plus plan per se and that we would have to submit a letter of predetermination to verify if it's covered.) I think that I had more detailed info in front of me (our Certificate of Coverage listing the exclusions for our policy) than she did! Anyone had or heard of anyone who has had success in fighting an exclusion?A huge thanks to so many who've replied to questions I've had since joining up last week. I feel so grateful for your help!Mom to , 8 months old

[Guest guest]

UHC also told use Hanger was under coverage, etc. But, then the claim was

denied. Even while my HR gal worked on getting a straight answer, we still went

ahead and had her head casted for a DOC band and paid out of pocket. UHC would

pay for an appt at Children's Hospital for someone to tell us what we should do

for her head. They are booked through January. I cancelled the appt. and went

to Cranial Tech. Clinic It has been a very frustrating process. UHC told me

they would only cover a band under 'certain circumstances'. i.e. Full Term baby

pulled out via forceps! hmm, our hospital does not even use those anymore! And

the people on the phone @ UHC are just reading the coverage off the computer.

Each case has different circumstances.

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> I can't answer your question directly, but I do have some information for you.

We have MDIPA, which is governed by UHC. They also had an exlusion in their

policy; however when we submitted the request, they responded by saying that

there was an exlusion, but that they would cover a band from Hanger. It was

really odd. We didn't get this information the first three times that we called

about it. It was in a letter that denied coverage for the STARband. I called

after getting the letter and the person on the phone had to spend a long time

looking things up before confirming that this was true. Well, I ended up not

wanting to wait to get the process started with Hanger because was

already 14 months old and a two week difference in getting started was enough

for me to go ahead and just pay out of pocket. To be honest, this makes

absolutely no sense, but it was what happened for us. So, go ahead and give it a

try.

>

>

>

> , mom to , 27 months

>

> STARbaand grad May 2009

>

> Chiro and CST

>

> land

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> Ticker id: IvP3   Ticker id: yZZP     Ticker id: lFno

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> Anyone With an Exclusion Gotten Insurance Coverage?

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> I've poured over hundreds of messages in this forum in the last few days and

have seen lots of cases where people successfully appealed; however, I don't

think I've seen one where anyone successfully appealed when there was an

exclusion on cranial banding written into their policy. Anyone have an exclusion

in their policy but was still able to get a helmet paid for by insurance?

>

> We have the United Healthcare Choice Plus plan, and the policy purchased by

our Employer has an exclusion for cranial banding. It seems pretty black and

white that the Insurance won't pay for this, since they specifically state that

they won't, so I'm wondering if I should even delay our helmet scanning/casting

to hear back about our predetermination. (If we wait to hear and are denied, we

definitely won't wait to cast until hearing back about an appeals--that would be

way too long. We'll just go ahead with it and plan to have to pay out of pocket

with maybe an attempt at an appeal.)

>

> The UHC rep said she couldn't even tell me over the phone whether there was an

exclusion in our specific policy (just that there isn't one in the Choice Plus

plan per se and that we would have to submit a letter of predetermination to

verify if it's covered.) I think that I had more detailed info in front of me

(our Certificate of Coverage listing the exclusions for our policy) than she

did!

>

> Anyone had or heard of anyone who has had success in fighting an exclusion?

>

> A huge thanks to so many who've replied to questions I've had since joining up

last week. I feel so grateful for your help!

>

>

> Mom to , 8 months old

>