Re: Need Help - Anyone been successful in getting UHC to cover the DOC Band?

April 8, 2011

We are about to begin the same journey for the very same exclusion with UHC. I

would love to see any info or responses you get on this and would be willing to

share. I wish you good luck in your fight.

Thanks!

>

> I am currently about to begin the appeals process with UHC to get my daughters

DOC band covered. Her first band received a denial because they said Cranial

was Out-Of-Network, and my plan didn't provide out of network coverage. Well,

effective 4/1, I am now on the UHC PPO plan, and I do have Out of Network

coverage...since my daughter outgrew her first band, and still needs further

treatment, we are going with a 2nd band, prescribed by her pediatrician, as her

plagiocephaly is still considered severe even after the first band. Well, UHC

has once again denied the claim citing the following exclusion " Braces that

straighten or change the shape of a body part are orthotic devices, and are

excluded from coverage. "

>

> I'm wondering if anyone has appealed UHC under this denial reason, and been

successful? If so, I would truly appreciate it if you would be willing to share

your letter, and supporting documentation that was provided with the appeal.

Also, if I could cite you within my appeal letter to prove a point that it has

been covered for others, and that this is considered discrimination of some sort

against my daughter? Just looking for anything I can on this.

>

> My husbands parents were gracious and kind enough to pay for our daughters

first band, and have offered to pay for this 2nd one, but I cannot in good

conscience take their money without putting up one heck of a fight with the

insurance company to get it back!!! Please, please help if you can.

>

> Thanks!

>

April 9, 2011

I have UHC and it covered, at an " out of network " cost a portion of the DOC band for our son. We only got about $845 back. But it was something. -- ~

April 9, 2011

I also am about to go though this process and United Health Care informed me that they only cover helmets if they are required post surgery. Another strike against us is that we have chosen to go out of network just because we feel like we are in the best hands. I would like to get any info that you guys can provide about appealing this. I was told not even to waste my time as they will just deny it. Maybe if there are enough of us with United Health Care we could start a petition or something. I have 2 letters stating medically necessary, I can't believe UHC feels this is cosmetic only. Thanks for taking the time to read and share your experience!

April 10, 2011

My son's band was denied coverage by UHC for the same reason, so I put a ton of

research into an appeal and it was just recently accepted - as Out of Network

since we chose to go with Cranial Technologies. I would definitely urge anyone

who has been denied coverage to keep appealing. Hopefully as awareness of plagio

increases, insurance companies will be forced to start recognizing it as a

medical condition and provide coverage as such. I got a lot of great info from

other parents in this group, which was a huge help. I would be happy to share my

appeal letter and will try to upload a copy.