Guest guest Posted June 25, 2002 Report Share Posted June 25, 2002 Barbara: I would begin your appeals letter now. I wish I could offer better advice, but I'll leave that up to other insurance sufferers, there are plenty of em in our group unfortunately I want to wish Sofia best of luck Thurs for her casting! Please let us know how it goes. Debbie Abby's mom DOCGrad MI > Marci and ann, > > Thank you for your advise. I live in Miami (our insurance is NJ due > to corporate office) and have a casting appointment for our 5 month > old daughter this Thursday with CT. We will pay for the procedure > and continue our dealings with our insurance company. This is all > new to me. I had no idea torticollis (which our daughter has) and > plagiocephaly existed and I would never have imagined that treatment > on a child would be denied by an insurance company. > > What we received (after 4 days of asking them to fax it) is a letter > that says that our request for a predetermination of beneifts has > been considered not medically necessary. Is this the same as a > denial letter? I did get the address of their Medical Advisor's > Office which made the decision and was told I could send in an appeal > to them. I was not given a name only a mail station number to > address it to. They said their Medical Advisors Office is made up of > Doctors who reviewed the paperwork on Sofia and made their decision. > Do I prepare the appeal letter now? CT has been very helpful and has > given me some research and articles. I'm not sure what our next step > should be. > > Any advise would be appreciated. Thank you. > > Barbara Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 27, 2002 Report Share Posted June 27, 2002 Definitely send the appeal. I believe there are many sample letters in one of the sections of this website. Get letters from your ped and specialist and submit that as well. I'm not sure exactly what else would be good to send to prove medical necessity but I'm sure someone here can help with that. Good luck and don't give up. There seem to be many success stories in this group in dealing with the ins co's. ann/ NJ > essage: 20 > Date: Tue, 25 Jun 2002 14:08:33 -0000 > From: " catasofia2002 " <catasofia2002@...> > Subject: Denied by BC/BS NJ??? > > Marci and ann, > > Thank you for your advise. I live in Miami (our insurance is NJ due > to corporate office) and have a casting appointment for our 5 month > old daughter this Thursday with CT. We will pay for the procedure > and continue our dealings with our insurance company. This is all > new to me. I had no idea torticollis (which our daughter has) and > plagiocephaly existed and I would never have imagined that treatment > on a child would be denied by an insurance company. > > What we received (after 4 days of asking them to fax it) is a letter > that says that our request for a predetermination of beneifts has > been considered not medically necessary. Is this the same as a > denial letter? I did get the address of their Medical Advisor's > Office which made the decision and was told I could send in an appeal > to them. I was not given a name only a mail station number to > address it to. They said their Medical Advisors Office is made up of > Doctors who reviewed the paperwork on Sofia and made their decision. > Do I prepare the appeal letter now? CT has been very helpful and has > given me some research and articles. I'm not sure what our next step > should be. > > Any advise would be appreciated. Thank you. > > Barbara > Quote Link to comment Share on other sites More sharing options...
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