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The mission of
PlagioCoach is to help you, the parent of a child with Plagiocephaly,
win insurance coverage for your child's cranial orthosis by providing you with
the information, tools and techniques that I successfully used to win coverage
for my daughter's cranial orthosis.
 I am Ian
Doris. I am a licensed certified civil trial attorney practicing law in New
Jersey. I have handled all types of cases including representing insurance
companies. I have never experienced such an egregious denial of coverage for
medically necessary treatment than the denial of coverage for cranial orthosis.
My daughter, a twin, was born one month premature. The head flattening
from birth got progressively worse despite aggressive repositioning. Our
pediatrician referred us to a plastic surgeon with craniofacial expertise and
he immediately diagnosed Plagiocephaly, prescribed the
DOC Band™ and
wrote a letter of medical necessity requesting pre-authorization. Our insurance
company denied coverage claiming lack of medical necessity. I filed two
internal appeals with the company as required by my policy and lost both times.
I proceeded to appeal to the N.J. Department of Health, the last level of
appeal required by my insurance policy, and they reversed the insurance
company's decision and ordered them to cover the cost of the DOC
Band™.
Even with my legal experience I was frustrated at
times. I have spoken with parents across the country, and I know you are
frustrated, intimidated and dejected by having to fight so hard to get coverage
for something that never should have been denied in the first place. Add the
demands of raising a newborn and other family obligations and it is easy to see
why many people give up.
One day while at my daughter's weekly visit, a
mother in the waiting room overheard my conversation about my appeal and asked
what I was doing. As I explained about the process she began to cry and told me
she had no idea there was such a process. She recognized she may have waited
too long to appeal. I empathized with this woman, who was obviously distraught.
That day I decided to do something to help. I wasn't sure how but as I
got deeper into research and preparing my own appeal, it became clear to me
that I could provide other parents with the benefit of my experience and the
formula I used to win coverage.
I hope you find
the manual,
classes,
coaching, and other
resources on this web site useful. I want to make a difference in your life and
help you win insurance coverage for your child's cranial orthosis.
Contact Ian to discuss how
his book, teleclasses, and 1-on-1 coaching can support you in winning
coverage!
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