Re: Help Opening Files

[Guest guest]

Hmmmmm...I was able to open those documents without a problem. Is it all of the

documents or just certain file types. I could convert the Word and Word Perfect

files to PDFs and upload them again, maybe that would work? But if you can't

open the PDFs either, I'm not sure what the problem is.

Jake-3 (DOCBand Grad 9/08)

>

> I'm new to the group and trying to appeal my insurance for at least some

coverage of cost. I've tried to open the files for insurance help " BCBS

Appeals " and keep getting this statement for each one, " the requested document

is not accessible " . I am able to open files in other folders, it's just the

folder specifically for BCBS that will not work. Any ideas on why it's not

working? How can I access these files?

>

> Any other tips on appealing appreciated.

>

> Many Thanks!

>

[Guest guest]

I successfully appealed. I have attached my letter (which has been redacted).

Hope it helps.

To Whom It May Concern:

This office has been retained to represent _______________in the appeal of their

claim for coverage for their son, _______________. I have received and reviewed

the letter received from ____________, dated _______________ denying coverage

for the Dynamic Orthotic Cranioplasty (DOC) banding therapy provided by Cranial

Technologies, Inc. Please accept this letter as the appeal of your decision to

deny coverage.

As support for the appeal, we enclose the following:

1. Medical history and subsequent diagnosis of deformational

plagiocephaly and torticollis;

2. Studies regarding the effectiveness of cranial banding;

3. Long term health effects if left untreated;

4. Options for treatment;

5. Legal analysis regarding a bad faith denial.

History/Diagnosis

[iNSERT HERE]

PROVEN Effectiveness of Cranial Banding

Fact #1

The DOC band received FDA approval in 1998 and was the first device cleared by

the US Food and Drug Administration for the treatment of Plagiocephaly. To

date, it is the ONLY device with clinical studies demonstrating safety and

effectiveness. According to the FDA's Indication for Use, it states " The DOC

band is intended for use on infants from three to eighteen months of age with

moderate to severe non-synostotic positional plagiocephaly . . . "

The Federal Register, Vol. 63, No. 146, published the United States Food and

Drug Administration approval in full detail on July 30, 1998.

Note: The United States Food and Drug Administration confirmed their 1998

recommendations in 1999 and 2001.

Fact #2

Several studies and articles have been written and documented to support the

effectiveness of this treatment (regardless of when the condition was acquired)

as well as the long-term effects due to untreated deformational plagiocephaly:

A. A five-year study was done between 1988 and 1993 on 124 infants with

positional plagiocephaly to determine the effectiveness of treatment with the

DOC band. In summary, based on the anthropometric data and clinical

observations, " D.O.C. is effective in achieving complete or near-complete

correction for nonsynostotic plagiocephaly characteristics. " It further states

that " It is an economical and non-evasive procedure that is well tolerated for

infants. Surgery for positional plagiocephaly is seldom needed. "

Ripley, CE, et al., Treatment of Positional Plagiocephaly with Dynamic

Orthotic Cranioplasty, The Journal of Craniofacial Surgery, 1994; 5:150-159.

B. A follow-up study was done to expand on the pilot investigation by reporting

on 285 patients who have been treated with D.O.C. band over the past eight

years. Their conclusion, " Our eight year results support the original

conclusions drawn on the pilot investigation which document the D.O.C. as an

effective, nonsurgical alternative for the treatment of positional

plagiocephaly. It has been demonstrated that the cranial vault, skull base, and

orbitotragial depth asymmetries can be corrected, and that the results remain

stable once an infant is removed from the treatment. "

Littlefield, TR; Pomatto, JK; Beals, SP; Manwarning, KH; Joganic, EF; Ripley,

CE (1997), Proceedings of the 7th International Congress of the International

Society of Craniofacial Surgery; pp. 109-111.

C. Guidelines were established at the 1997 Craniosynostosis and Skull Molding

Symposium as to the best method for the treatment of plagiocephaly. These

guidelines state that " f repositioning is unsuccessful, or if the initial

deformity is too severe, or if the child is over 5-6 months of age, ORTHOTIC

MANAGEMENT should be considered as the next logical alternative. " (Emphasis

added.)

These guidelines are endorsed by the following Medical

Societies/Organizations:

American Association of Pediatric Neurosurgeons

American Cleft Palate/Craniofacial Society

American Society of Craniofacial Surgeons

American Society of Maxillofacial Surgeons

American Association of Pediatric Plastic Surgeons

Section of Plastic Surgery of the American Academy of Pediatrics

, K., et al., Cranial Growth Unrestricted During Treatment of

Deformational Plagiocephaly, Pediatric Neurosurgery, (1999); 30:193-199.

D. According to Cedar-Sinai Medical Center, Department of Pediatrics position

in the management of plagiocephalty and torticollis, " Management for infants who

do not make progress with exercise alone, or for infants with moderate to severe

plagiocephaly still present at 6 months, involved the use of the corrective

helmet . . The results have been excellent. . . "

Graham, J.; Cedar-Sinai Medical Center Pediatrics/Medical Genetics: Management

of Plagiocephaly and Torticollis, Ahmansan Pediatric Center/Cedar Sinai Medical

Center.

E. As noted by Dr. Deidra Marshall of Miami's Children's Hospital, " Insurance

companies and HMO's must realize that prompt authorization of requests for

helmet therapy in children requiring them will, in the long run, be much more

cost-effective than denying or postponing authorization for a helmet and then

having to fund a major intra cranial surgical procedure. "

Marshall, Deidra, MD, et al., Abnormal Head Shape in Infants, International

Pediatrics: The Journal of Miami Children's Hospital, 1997; 12:175.

Long Term health Effects of Untreated Conditions

Untreated/uncorrected plagiocephaly has been linked to several medical problems

later in a child's life, including, but not limited to, respiratory and vision

problems, migraine headaches, difficulty chewing, TMJ, and increased ear

infections, as well as psychological consequences.

Result from a study by Kane, et al. (1996) suggest, " [t]hat the skull asymmetry

in positional plagiocephaly can cause growth deformities in other bones, such as

the mandible, which may lead to significant dental abnormalities and create

difficulties with the temporomandibular joint. "

Kane, A.; , L.; and Craven, K., et al.; Observations on a recent

increase in Plagiocephaly without synostosis. Pediatrics. 1996; 97:877-885.

" Severe skull asymmetry can also cause deformity of the orbit, with the

potential for ocular disturbances such as strabismus and abnormalities in ocular

motility. "

Huang, M.; Mouradian, W.; and Cohan, S., et al. The Differential Diagnosis of

Abnormal Head Shapes; Separating Craniosynostosis from Positional Deformities

and Normal Variants. Cleft Palate Craniofacial Journal. 1998; 35:204-211.

" ...as the number of cranial strain patterns increase, so did the incidence of

middle ear infections. "

Cranial Dysfunctions in Ottis Media, WholeHealth Library/Osteopathy, American

WholeHealth, Inc., www.americanwholehealth.com/library/osteopathy

Options for Treatment

In reviewing the materials provided to them by their pediatrician, as well as

additional independent research conducted, the ____________ see only the

following options for treatment of _______________ diagnosed conditions:

1. No Treatment. Given the well-documented potential for short and long-term

physical developmental and psychological problems, this option is unacceptable.

It has been demonstrated that early intervention is essential to successfully

correct the deformity. Further, the research demonstrated that time is of the

essence and the optimal time to begin treatment was within 4-6 months.

2. Surgical Intervention. While surgery has not been immediately deemed

necessary, should ___________ condition continued to deteriorate, it may be

required. The cost of surgery can be ten to twenty times the cost of a DOC

band. The Insurance Company's policy provides that " Cranial Banding " is a

covered procedure under " Durable Medical Equipment " for a maximum of $2,500.00.

As you can see the cost of the DOC band versus the cost of later cranial surgery

would be upwards of $50,000.00.

3. Cranial Banding. This non-evasive, relatively inexpensive, pain-free

procedure is by far the best option. This specific therapy is covered by more

than 90% of insurance companies. Although his parents are not anxious to put

________ through any medical treatment at such an early age, this situation, and

the time line of effective treatment warrant the banding therapy and the Compos'

believe that it is the best option for their son.

Based on the foregoing, ________________ requires cranial banding therapy.

Further, Cranial Technologies, Inc. is the industry leader for such therapy and

was recommended by ______________ doctor. The documentation provided above

specifically attests to the fact that lack of treatment will lead to physical,

developmental and psychological difficulties. The ____________ are troubled by

the fact that despite the recommendations of their pediatrician and statement

that the treatment is medically necessary has denied coverage.

We ask that you rescind your decision to deny coverage and make payment to the

___________, care of this office, in the amount of $_____________, based on your

schedule of benefits, within 30 days of the date of this letter.

>

> I'm new to the group and trying to appeal my insurance for at least some

coverage of cost. I've tried to open the files for insurance help " BCBS

Appeals " and keep getting this statement for each one, " the requested document

is not accessible " . I am able to open files in other folders, it's just the

folder specifically for BCBS that will not work. Any ideas on why it's not

working? How can I access these files?

>

> Any other tips on appealing appreciated.

>

> Many Thanks!

>