Anyone With an Exclusion Gotten Insurance Coverage?

[Guest guest]

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