Insurance

[Guest guest]

Hey guys!

I'm trying to set up a surgery to have my lower jaw advanced:

I just got my rejection letter from my Insurance company, and their

reason for rejecting was because the x-rays were too dark to read.

They have requested new x-rays and office notes to be sent back in

the appeal.

I spoke with my surgeon's admin staff about it yesterday and they

told me they were putting together the appeal, and that I should

write a letter to the Insurance company as well and describe my jaw

problems and the pain I am in to them as well. (I'm really not in

any kind of pain unless I chew gum or eat something that requires a

lot of chewing. I can describe that I guess..)

I guess I'm wondering exactly what kind of letter I'm supposed to

send to the Insurance company, when they were pretty clear about what

information they were looking for... Readable x-rays and office

notes, things that I can't provide. Would sending the insurance

company a sob story really influence them one way or another?

Because that's what I feel like I'm being asked to do, and I never

would have guessed that insurance companies would be succeptable to

sob stories.

Has anyone else had to put together a letter like this? If so, what

did you say?

Thanks!!

-Jen

[Guest guest]

Hi! I'm three weeks post-op today and didn't get my insurance

approval until 5 days before my surgery. The original claim and

first appeal were denied in part because of insufficient information

from the surgeon's office (his staff dropped the ball), including x-

rays that were not readable because they were faxed. I wrote a

letter like the one you described, and wrote one for my surgeon to

edit and sign. Describe any problems you have chewing (I had an open

bite and couldn't chew things with skins like fruit and vegetables

because my molars didn't touch). Also, any pain that you have,

including pain in your teeth from your bite putting too much pressure

on some teeth more than others. If you've had gum recession,

irregular wear on your molars, headaches, or any other related

issues, list them too. I also detailed my orthodontics and oral

surgery as a teenager (I'm 34 on my second round of braces now) and

told them the cost of my braces (in other words, there's no way I'd

be paying that for something cosmetic). I still think the most

convincing thing was having my orthodontist write a letter telling

them everything that was wrong with my bite (at the time of the

surgery, I only had three teeth that touched) and stating very

clearly that there was nothing he could do orthodontically to fix my

bite without surgery. Keep on fighting--they gamble on people giving

up. It doesn't hurt to write them a letter on a lawyer's letterhead

if you can arrange that. Also, if you think that your doctor's

office is not getting things together in a timely manner, you might

consider collecting everything yourself. For my last appeal, I went

to the orthodontist's office and took pictures of my molds from every

angle. I went to the surgeon and got copies of the x-rays, the

letter from the surgeon, cephalometric drawings, etc... and mailed

everything (including my own letter) in one Fed Ex package to the

insurance company. Keep copies of everything! Best of luck--fight

the good fight! --Amy

> Hey guys!

>

> I'm trying to set up a surgery to have my lower jaw advanced:

>

> I just got my rejection letter from my Insurance company, and their

> reason for rejecting was because the x-rays were too dark to read.

> They have requested new x-rays and office notes to be sent back in

> the appeal.

>

> I spoke with my surgeon's admin staff about it yesterday and they

> told me they were putting together the appeal, and that I should

> write a letter to the Insurance company as well and describe my jaw

> problems and the pain I am in to them as well. (I'm really not in

> any kind of pain unless I chew gum or eat something that requires a

> lot of chewing. I can describe that I guess..)

>

> I guess I'm wondering exactly what kind of letter I'm supposed to

> send to the Insurance company, when they were pretty clear about

what

> information they were looking for... Readable x-rays and office

> notes, things that I can't provide. Would sending the insurance

> company a sob story really influence them one way or another?

> Because that's what I feel like I'm being asked to do, and I never

> would have guessed that insurance companies would be succeptable to

> sob stories.

>

> Has anyone else had to put together a letter like this? If so,

what

> did you say?

>

> Thanks!!

> -Jen