Re: Brachycephaly Ins Help!

[Guest guest]

I would ask CT if they have any " published Peer reviewed medical literature "

which you can submit to appeal this rejection. I'm pretty sure there must be

some.

-christine

sydney, 4 yrs, starband grad

>

> Our Daughter was diagnosed with Severe Brachycephaly from Cranial Tech. in

Pasadena, California when she was 4.5 months. BCBS Ins denied coverage so we

paid out of pocket and our Daughter is in her 7th week of the DOC Band with

good results thus far. Our Ped doctor advised us to appeal the ins company so i

did make a first appeal with help from this club. Today 2/6/10 just got a

letter that initial denial is being " upheld " . The reason was that our daughter

" was diagnosed with Brachycephaly and the use of an adjustable cranial orthosis

is considered Investigational and not Medically necessary as a treatment of

Brachycephaly " . " There is no documentation in the published peer reviewed

medical literature which establishes the success of an adjustable cranial

Orthosis as treatment of Brachycephaly " .

>

> Cranial tech said that our daughter did not have Plagiocephaly as her numbers

were in Normal range but had severe Brachycephaly.

>

> Anyone have some advise?

>

> Our Doc said that we would not need a " Letter of medical Necessity " for the

first appeal.

>

> Im planning on 2nd appeal but need some help..

>

> thanks

>

> M

>

[Guest guest]

Go on the cranial tech website, click on " community " on the top right and then

choose " insurance information " . Scroll down to " insruance appeals " and downlaod

" The Insurance Game " pdf. If gives specific advice on appeal letters, including

info about what to say if your insurance claims a band is experimental or not

medically necessary.

>

> Our Daughter was diagnosed with Severe Brachycephaly from Cranial Tech. in

Pasadena, California when she was 4.5 months. BCBS Ins denied coverage so we

paid out of pocket and our Daughter is in her 7th week of the DOC Band with

good results thus far. Our Ped doctor advised us to appeal the ins company so i

did make a first appeal with help from this club. Today 2/6/10 just got a

letter that initial denial is being " upheld " . The reason was that our daughter

" was diagnosed with Brachycephaly and the use of an adjustable cranial orthosis

is considered Investigational and not Medically necessary as a treatment of

Brachycephaly " . " There is no documentation in the published peer reviewed

medical literature which establishes the success of an adjustable cranial

Orthosis as treatment of Brachycephaly " .

>

> Cranial tech said that our daughter did not have Plagiocephaly as her numbers

were in Normal range but had severe Brachycephaly.

>

> Anyone have some advise?

>

> Our Doc said that we would not need a " Letter of medical Necessity " for the

first appeal.

>

> Im planning on 2nd appeal but need some help..

>

> thanks

>

> M

>

[Guest guest]

Hie M.

I have BCBS of Tx and our son had the same condition and of course we were

denied when we submitted our claim the reason given to us was " out of network " .

Therefore we appealed it was a long wait but we received 70% of the cost back. I

am surprised your pediatrician dint give you a letter we only appealed once and

our Dr provided us w/ a " letter of medically necessity " I advise you to appeal

again, submit all available information pictures, evaluation/measurement report,

RX note, letters (yours, pediatrician and therapist) & information about the

condition and the band, from, side effects, the importance of using it, FDA

approval, references & so on.. *Mentioning you have joined a support group and

that you are in constant communication with people who have had the same

insurance and have received coverage for the band helps out as well. Hope this

advise helps out. Don't give up.

Website that I found, very helpful when I appealed. Great information on

insurance appeals. Good Luck

http://www.cappskids.org/plagioinformation.htm

>

> Our Daughter was diagnosed with Severe Brachycephaly from Cranial Tech. in

Pasadena, California when she was 4.5 months. BCBS Ins denied coverage so we

paid out of pocket and our Daughter is in her 7th week of the DOC Band with

good results thus far. Our Ped doctor advised us to appeal the ins company so i

did make a first appeal with help from this club. Today 2/6/10 just got a

letter that initial denial is being " upheld " . The reason was that our daughter

" was diagnosed with Brachycephaly and the use of an adjustable cranial orthosis

is considered Investigational and not Medically necessary as a treatment of

Brachycephaly " . " There is no documentation in the published peer reviewed

medical literature which establishes the success of an adjustable cranial

Orthosis as treatment of Brachycephaly " .

>

> Cranial tech said that our daughter did not have Plagiocephaly as her numbers

were in Normal range but had severe Brachycephaly.

>

> Anyone have some advise?

>

> Our Doc said that we would not need a " Letter of medical Necessity " for the

first appeal.

>

> Im planning on 2nd appeal but need some help..

>

> thanks

>

> M

>