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

[Guest guest]

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!