Re: United Healthcare Appeal Success

[Guest guest]

Hi . That's great news and great information...congratulations and thanks so much for the information.

I have a couple of questions. We have Cigna and I'm trying to appeal as well but there is an exclusion on the policy...was that your situation as well...that it was an exclusion? I did contact the HR Dept. to see if they could change the policy but they said no and even if they could, it wouldn't matter b/c the change would've taken place AFTER we got the band for my son and they wouldn't/couldn't make it retroactive. So, when your HR Dept. changed the exclusion to allow for cranial bands it didn't matter that the change was made AFTER your child had the band?

Thanks so much!

From: natalie <nat.jo.c@...>Subject: United Healthcare Appeal SuccessPlagiocephaly Date: Tuesday, October 26, 2010, 9:27 AM

Hi, I saw the post asking if there was any success in appealing United Healthcare. I was successful!!! This is the actual process I went through- feel free to e-mail me if you have more in depth questions:1. Initial request for coverage denied2. Appealed (you don't need to worry about providing much documentation here)3. Second Appeal was denied and this time I sent tons of documents, letters, the whole sh'bang. 4. Now after two denied appeals- this is when you can appeal your policy to your human resource department. I advise you keep them in the loop the entire time, so they aren't shocked by your appeal and have some sympathy on what's going on. Some departments are allowed to rewrite the policy to take out the exlusion on cranial bands. (I knew my department could do this and she advised me upfront to appeal twice with United Healthcare and then to them- she sord of said this under the table- but she knew I was

emotionally so stressed so I think she let it slip. She never mentioned it again though so I had to have some faith she was going to hold her end of the deal at the end- an entire year later actually.) If yours is one of them, then you can appeal but if they don't actually have the ability to make changes to your insurance policy then I am not sure you could be successful? So send the human resource department everything you have sent the insurance company and then write a 3rd letter of appeal to your Health Plan Administrator. We won this one and within a week of sumbitting it we finally had a nice check in the mail from United Healthcare with no problems. We weren't allowed to appeal to the Health Plan Admin until we were formally denied twice by United Healthcare. It was a lengthy process- but well worth it. Hope this helps! nat.jo.c@...

[Guest guest]

Hey ,

Yes, it was an exclusion- one reason I had no faith in appealing with the

insurance. The HR department told me I would still have to appeal it twice.

Sounds like your HR department CAN change your policy- I would dig a little

deeper. My daughter was completely done with treatment by the time we appealed

my HR Department so apparently my HR Department could make it retroactive. I

pretty much at one point cried to the HR Lady (who I still have never met in

person) and just apologized if I seemed too persisent or even rude and just told

her we work hard to cover rent and bills and diapers, much less a $4,000 cranial

band my daughter desperately needed. I think that worked... she was always a

little sweeter from that point on. I am not a crier, but glad I finally broke

down that day and to her!

I really hope you can work it out. We used the carenow credit card to make 12

month payments no interest praying we would get the reimbursement before the 12

months was up to pay it off. On the 12 month, we go the check and I paid what

was left off and had extra to put back in savings... That carenow card really

helped us.

Good luck!! If you have any more questions send them my way... sometimes it's

better to e-mail me. I don't check this site very often anymore...

>

>

> From: natalie <nat.jo.c@...>

> Subject: United Healthcare Appeal Success

> Plagiocephaly

> Date: Tuesday, October 26, 2010, 9:27 AM

>

>

>  

>

>

>

> Hi,

> I saw the post asking if there was any success in appealing United Healthcare.

I was successful!!! This is the actual process I went through- feel free to

e-mail me if you have more in depth questions:

>

> 1. Initial request for coverage denied

> 2. Appealed (you don't need to worry about providing much documentation here)

> 3. Second Appeal was denied and this time I sent tons of documents, letters,

the whole sh'bang.

> 4. Now after two denied appeals- this is when you can appeal your policy to

your human resource department. I advise you keep them in the loop the entire

time, so they aren't shocked by your appeal and have some sympathy on what's

going on. Some departments are allowed to rewrite the policy to take out the

exlusion on cranial bands. (I knew my department could do this and she advised

me upfront to appeal twice with United Healthcare and then to them- she sord of

said this under the table- but she knew I was emotionally so stressed so I think

she let it slip. She never mentioned it again though so I had to have some faith

she was going to hold her end of the deal at the end- an entire year later

actually.) If yours is one of them, then you can appeal but if they don't

actually have the ability to make changes to your insurance policy then I am not

sure you could be successful? So send the human resource department everything

you have sent the insurance

> company and then write a 3rd letter of appeal to your Health Plan

Administrator. We won this one and within a week of sumbitting it we finally had

a nice check in the mail from United Healthcare with no problems. We weren't

allowed to appeal to the Health Plan Admin until we were formally denied twice

by United Healthcare. It was a lengthy process- but well worth it.

>

> Hope this helps!

>

> nat.jo.c@...

>

[Guest guest]

Hi ,

We are in process of appealing as well.

Can you let us know what was included in the documentation that was required and

what your child's measurements were? I believe that has an impact on the

decision, but am going to try regardless.

Thanks for the information!

-m

> >

> >

> > From: natalie <nat.jo.c@>

> > Subject: United Healthcare Appeal Success

> > Plagiocephaly

> > Date: Tuesday, October 26, 2010, 9:27 AM

> >

> >

> >  

> >

> >

> >

> > Hi,

> > I saw the post asking if there was any success in appealing United

Healthcare. I was successful!!! This is the actual process I went through- feel

free to e-mail me if you have more in depth questions:

> >

> > 1. Initial request for coverage denied

> > 2. Appealed (you don't need to worry about providing much documentation

here)

> > 3. Second Appeal was denied and this time I sent tons of documents, letters,

the whole sh'bang.

> > 4. Now after two denied appeals- this is when you can appeal your policy to

your human resource department. I advise you keep them in the loop the entire

time, so they aren't shocked by your appeal and have some sympathy on what's

going on. Some departments are allowed to rewrite the policy to take out the

exlusion on cranial bands. (I knew my department could do this and she advised

me upfront to appeal twice with United Healthcare and then to them- she sord of

said this under the table- but she knew I was emotionally so stressed so I think

she let it slip. She never mentioned it again though so I had to have some faith

she was going to hold her end of the deal at the end- an entire year later

actually.) If yours is one of them, then you can appeal but if they don't

actually have the ability to make changes to your insurance policy then I am not

sure you could be successful? So send the human resource department everything

you have sent the insurance

> > company and then write a 3rd letter of appeal to your Health Plan

Administrator. We won this one and within a week of sumbitting it we finally had

a nice check in the mail from United Healthcare with no problems. We weren't

allowed to appeal to the Health Plan Admin until we were formally denied twice

by United Healthcare. It was a lengthy process- but well worth it.

> >

> > Hope this helps!

> >

> > nat.jo.c@

> >

>