Insurance denied: its bad, but not bad enough

[Guest guest]

Hi,

Our insurance denied our physicians referral for a doc band from CT because our

sons plagio and brachycephaly isnt bad enough to qualify as a " medical

necessity " . The back of his head is totally flat! I don't get it. What

arguments have other parents used when appealing these decisions from insurance

companies? Our doctor will write another letter for us and we are going to

include the photo study from CT but I think if I can write a letter with

reference to other studies that would help too. If you have the time, please

send me any information you can to help us win our appeal.

Thanks so much,

Mandy and Pete

[Guest guest]

Just curious what numbers that CT gave you that the insurance company would deny

you...they say insurance companies are about the numbers!!!

Good luck

DC

>

> Hi,

>

> Our insurance denied our physicians referral for a doc band from CT because

our sons plagio and brachycephaly isnt bad enough to qualify as a " medical

necessity " . The back of his head is totally flat! I don't get it. What

arguments have other parents used when appealing these decisions from insurance

companies? Our doctor will write another letter for us and we are going to

include the photo study from CT but I think if I can write a letter with

reference to other studies that would help too. If you have the time, please

send me any information you can to help us win our appeal.

>

> Thanks so much,

>

> Mandy and Pete

>

[Guest guest]

With Kaiser, if you can get a doctor to write a prescription, they don't fight

it at all. If it's an option where any of you guys live who are considering a

helmet, switch to Kaiser. My ortho requested a prescription based on the

Starscan and 2 weeks later, the helmet was on order.

Someone else who had trouble with their insurance said they recommended paying

for the helmet, then fighting for reimbursement so they could get the helmet

working as soon as possible. If you have the money or can borrow it, don't rule

that out. There is so much more awareness now too I think any CVA over 6 always

wins with the insurance companies -- eventually.

Best of luck!

> >

> > Hi,

> >

> > Our insurance denied our physicians referral for a doc band from CT because

our sons plagio and brachycephaly isnt bad enough to qualify as a " medical

necessity " . The back of his head is totally flat! I don't get it. What

arguments have other parents used when appealing these decisions from insurance

companies? Our doctor will write another letter for us and we are going to

include the photo study from CT but I think if I can write a letter with

reference to other studies that would help too. If you have the time, please

send me any information you can to help us win our appeal.

> >

> > Thanks so much,

> >

> > Mandy and Pete

> >

>

[Guest guest]

We have Healthnet and chose to pay for the helmet and battle the insurance

afterward. Most insurance companies want to see a 6 or higher.

However, Healthnet wants to see a 12 before they will cover it!!! Ridiculous.

Thankfully she was over 12 and we have an awesome pediatrician who is willing to

fight the insurance companies. He hasn't lost yet.

I have heard several people say great things about Kaiser.

Good luck,

Des

Zoey 8.5 months STARband 1/4/10

> > >

> > > Hi,

> > >

> > > Our insurance denied our physicians referral for a doc band from CT

because our sons plagio and brachycephaly isnt bad enough to qualify as a

" medical necessity " . The back of his head is totally flat! I don't get it.

What arguments have other parents used when appealing these decisions from

insurance companies? Our doctor will write another letter for us and we are

going to include the photo study from CT but I think if I can write a letter

with reference to other studies that would help too. If you have the time,

please send me any information you can to help us win our appeal.

> > >

> > > Thanks so much,

> > >

> > > Mandy and Pete

> > >

> >

>