Guest guest Posted August 15, 2000 Report Share Posted August 15, 2000 Ann Ledbetter wrote: > > I am desperate for some help. My insurance company turned me down for the > second time today. The first denial said it was not medically necessary. > I have gotten the reason for the second denial yet. I am sure it will be > the same. > > I have to have the surgery. Does anyone have any suggestions for my next > attempt at my appeal? > > Desperate > > Ann Yes. You have to find out what their criteria is that they use to establish that the surgery is medically necessary. The packet that was sent to them is MISSING something -- one or more things. It could be something like they require a pscychological evaluation, or proof that you have been on medically supervised diets in the past. Whatever was missing, you need to find out what that was and send it to them. Then you will qualify as medically necessary and be approved. Don't go off on a tangent sending them all sorts of nonsense they didn't ask for and don't need and don't send them your life story. If you send them a lot of irrelevant stuff they don't want or need, you are actually HELPING them to deny you -- they look at it, decide they don't want to wade through it, they see a lot of it is irrelevant, and deny you out of hand. When they say you didn't establish that the procedure was medically necessary, then they are telling you that they are *missing* something that *they* require and they are not going to volunteer it to you -- they hope you don't know enough to ask what it is. But ask. Demand to know what was missing. Get that. Send it in. Before you send it, get the name, department, and phone number of a person to send it to and the correct mailing address. Mail it to that person, by name and department, and by certified mail. Also get a fax number. Fax it to them with a COVER PAGE that is specifically addressed to the person who's name and department and phone number you got. Kind regards, Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 15, 2000 Report Share Posted August 15, 2000 Ann, is right. You don't need to overload with information not needed or warranted. Also, talking with your PCP and seeing if you can enlist his support by maybe writing a letter on your behalf documenting some medical info. in the way only doctors can get through to doctors may help. A lot of times I have the doctors in my practice to make phone calls to the insurance companies when I have tried all else. One of the problems that exsist in Insurance companies is that the doctors there have been out of practice for a while. They are not as up-to-date on things as they sometimes should be. Also, some of the doctors are regular mds and specialities are kinda out of their league and instead of going to theire sources they kinda leave it as not medically necessary. Good luck and if you still have problems email me and I will see what I can do to help. Jai > > > > I am desperate for some help. My insurance company turned me down for the > > second time today. The first denial said it was not medically necessary. > > I have gotten the reason for the second denial yet. I am sure it will be > > the same. > > > > I have to have the surgery. Does anyone have any suggestions for my next > > attempt at my appeal? > > > > Desperate > > > > Ann > > > Yes. You have to find out what their criteria is that they use to > establish that the surgery is medically necessary. > > The packet that was sent to them is MISSING something -- one or more > things. It could be something like they require a pscychological > evaluation, or proof that you have been on medically supervised diets in > the past. > > Whatever was missing, you need to find out what that was and send it to > them. Then you will qualify as medically necessary and be approved. > > Don't go off on a tangent sending them all sorts of nonsense they didn't > ask for and don't need and don't send them your life story. > > If you send them a lot of irrelevant stuff they don't want or need, you > are actually HELPING them to deny you -- they look at it, decide they > don't want to wade through it, they see a lot of it is irrelevant, and > deny you out of hand. > > When they say you didn't establish that the procedure was medically > necessary, then they are telling you that they are *missing* something > that *they* require and they are not going to volunteer it to you -- > they hope you don't know enough to ask what it is. > > But ask. Demand to know what was missing. Get that. Send it in. > > Before you send it, get the name, department, and phone number of a > person to send it to and the correct mailing address. Mail it to that > person, by name and department, and by certified mail. > > Also get a fax number. Fax it to them with a COVER PAGE that is > specifically addressed to the person who's name and department and phone > number you got. > > Kind regards, > > Quote Link to comment Share on other sites More sharing options...
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