Guest guest Posted November 7, 2004 Report Share Posted November 7, 2004 I just got a denial letter back from my insurance (BCBS of Mass.)the other day. The letter stated that my surgery wasn't found to be " Medically Necessary " . Is there anyone out there who has worked with this insurance company and/or had to deal with a denial letter like this? How does one prove to an insurance company that a lower jaw surgery is " medically necessary " ? Could the decision get changed if I fight through appeal? Any help would be great. -nate Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 7, 2004 Report Share Posted November 7, 2004 I just got a denial letter back from my insurance (BCBS of Mass.)the other day. The letter stated that my surgery wasn't found to be " Medically Necessary " . Is there anyone out there who has worked with this insurance company and/or had to deal with a denial letter like this? How does one prove to an insurance company that a lower jaw surgery is " medically necessary " ? Could the decision get changed if I fight through appeal? Any help would be great. -nate Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 8, 2004 Report Share Posted November 8, 2004 I think you need a surgeon to help you with the application. My surgeon filed the whole thing for me, complete with molds, photographs, drawings, x-rays, and a most excellent letter explaining that the procedures were not cosmetic, not for TMJ trouble, etc., but rather for repair of a congenital malformation of the lower jaw. You'll need to get started with an appeal, I think -- or at least send them notice that you are preparing an appeal. Read your policy for how to do that. I had to do it with Blue Cross down here on another whole matter, and wrote them requesting a review by a panel of oral and maxillofacial surgeons. Read your policy to see what rights you have. Good luck, Cammie > > I just got a denial letter back from my insurance (BCBS of Mass.) the > other day. The letter stated that my surgery wasn't found to > be " Medically Necessary " . Is there anyone out there who has worked > with this insurance company and/or had to deal with a denial letter > like this? How does one prove to an insurance company that a lower > jaw surgery is " medically necessary " ? Could the decision get changed > if I fight through appeal? Any help would be great. > > -nate Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 8, 2004 Report Share Posted November 8, 2004 I think you need a surgeon to help you with the application. My surgeon filed the whole thing for me, complete with molds, photographs, drawings, x-rays, and a most excellent letter explaining that the procedures were not cosmetic, not for TMJ trouble, etc., but rather for repair of a congenital malformation of the lower jaw. You'll need to get started with an appeal, I think -- or at least send them notice that you are preparing an appeal. Read your policy for how to do that. I had to do it with Blue Cross down here on another whole matter, and wrote them requesting a review by a panel of oral and maxillofacial surgeons. Read your policy to see what rights you have. Good luck, Cammie > > I just got a denial letter back from my insurance (BCBS of Mass.) the > other day. The letter stated that my surgery wasn't found to > be " Medically Necessary " . Is there anyone out there who has worked > with this insurance company and/or had to deal with a denial letter > like this? How does one prove to an insurance company that a lower > jaw surgery is " medically necessary " ? Could the decision get changed > if I fight through appeal? Any help would be great. > > -nate Quote Link to comment Share on other sites More sharing options...
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