Re: Insurance - Orthotics Appeal

[Guest guest]

I had my doctor write a letter explaining why i needed the certain braces that i

needed at the time and then had my brother-in-law (an attorney) put it on his

letterhead. Next thing I knew, the insurance company " reconsidered " my claim.

Jackie

Insurance - Orthotics Appeal

 

I looked in the files, but I did not see anything. I am sorry. I know we have

probably talked about this before. I am wanted to appeal my insurance claim.

They did not cover any of my most recent custom inserts, which I desperately

need for pain relief and gait correction. If anyone here has had success with

this, please advise me on what I should say in my appeal letter.

[Guest guest]

Hi ,

Insurance plans vary quite a bit in the type of coverage they will provide for

custom-molded inserts.  Most plans provide some coverage as long as the inserts

are custom-molded (i.e. casted), not just a modified off-the-shelf product,

though most plans have annual dollar or quantity limits.  There are also some

plans that exclude coverage entirely (regardless of medical necessity), except

as required by law. 

To know what to say in an appeal, you have to understand why they denied the

claim.  For example, perhaps the doctor didn't bill the inserts as

'custom-molded', but as an 'off the shelf' product, or perhaps a referral was

needed first, etc.  There are many reasons why a denial may occur.  Look at

the reason for the denial (or contact customer service to explain it) and

compare that reason to the contract as well as your situation.  If there's an

error, that's the basis of your appeal.

________________________________

From: cathy.power <slumpville@...>

Sent: Thu, April 15, 2010 7:13:29 AM

Subject: Insurance - Orthotics Appeal

 

I looked in the files, but I did not see anything. I am sorry. I know we have

probably talked about this before. I am wanted to appeal my insurance claim.

They did not cover any of my most recent custom inserts, which I desperately

need for pain relief and gait correction. If anyone here has had success with

this, please advise me on what I should say in my appeal letter.

[Guest guest]

,

I appealed when they denied my orthotics and I won. I guess they think ppl who

have normal feet but are just on them a lot are trying to get them to pay for

something just to make their day more comfortable, not realizing there is a real

reason.

I just wrote a letter explaining that they were necessary due to my condition

known as CMT and then I explained what CMT is and what the symptoms were, etc.

Then, (and my hubby said this alone would have won my case) I included photos of

my feet from the side and with me standing from the back. My feet are so

misshaped who wouldn't realize I had a problem? :-)

That was all it took, I received a letter back within a couple weeks stating

that they would pay.

Now, that was with our previous insurer and I was told by our new one that all I

needed was a Letter Of Medical Necessity from my doctor. So, you may want to

try that first, or do both. Good luck!

Angie

>

> I looked in the files, but I did not see anything. I am sorry. I know we have

probably talked about this before. I am wanted to appeal my insurance claim.

They did not cover any of my most recent custom inserts, which I desperately

need for pain relief and gait correction. If anyone here has had success with

this, please advise me on what I should say in my appeal letter.

>

[Guest guest]

I have appealed and won twice.

In a message dated 4/15/2010 9:29:54 A.M. Pacific Daylight Time,

slumpville@... writes:

I am wanted to appeal my insurance claim. They did not cover any of my

most recent custom inserts, which I desperately need for pain relief and gait

correction. If anyone here has had success with this, please advise me on

what I should say in my appeal letter.

[Guest guest]

I have appealed and won twice after we were told that the AFOS were not

medically necessary.

In a message dated 4/15/2010 9:29:54 A.M. Pacific Daylight Time,

slumpville@... writes:

I looked in the files, but I did not see anything. I am sorry. I know we

have probably talked about this before. I am wanted to appeal my insurance

claim. They did not cover any of my most recent custom inserts, which I

desperately need for pain relief and gait correction. If anyone here has had

success with this, please advise me on what I should say in my appeal letter.