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Hi. We have CareFirst in Virginia and had to have 2 bands. Both were denied by

CareFirst because they consider it cosmetic. I appealed as far as I could go

through the Dept. of Health Care Finance who reccommended that CareFirst cover

the treatments fully. CareFirst rejected their recommendation and now my only

option is to file a civil suit against CareFirst. Has anyone had a similiar

experience or know of anyone who has gone this far? Thanks.

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I haven't, but you can search thru the files for appeals. There may be

more info and helpful stuff there.

Plagiocephaly/files/Insurance%20Help/

Jen

Mom to Luli - 3 yrs old

Torticollis, Plagio, Syringomyelia

insurance denial

Hi. We have CareFirst in Virginia and had to have 2 bands. Both were

denied by CareFirst because they consider it cosmetic. I appealed as

far as I could go through the Dept. of Health Care Finance who

reccommended that CareFirst cover the treatments fully. CareFirst

rejected their recommendation and now my only option is to file a civil

suit against CareFirst. Has anyone had a similiar experience or know

of anyone who has gone this far? Thanks.

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  • 4 months later...
Guest guest

Sorry to hear that - how frustrating! You will probably get better help if you

can tell us all about your insurance - who the insurer is, the type of plan, and

the state where you live. Is it through an employer, etc? There is often someone

else on the board who's been in a similar situation. I agree with the last post

about finding out exactly what their guidelines are. Ask for a copy of the part

of your policy that says you don't qualify. Hopefully, you will find out that

you actually DO qualify and they were wrong. Also, find out what laws govern

your insurance plan and read them to find out if they are allowed to exclude

coverage. If you tell us more about your insurance, we can probably be more

specific with our advice.

Good luck!

> >

> > Not sure if anyone can help. My daughter has moderate-severe deformational

plagiocephaly. Our insurance company denied our claim because they said they

are only covered for adjunctive use for infants from 3-18mts of age whose

synostosis has been surgically corrected, but who still have moderate to severe

cranial deformities.

> >

> > Not really sure where to go from here. I'd be grateful for any help. thanks

> >

> > Lucy's Mom

> >

>

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