Guest guest Posted January 5, 2005 Report Share Posted January 5, 2005 to get my insurance (blue cross) to cover the surgery, i had to have the OS write a letter stating why the procedure was a medical neccessity. They are used to doing it all, so they handled it for me, so i would suggest asking the OS if he has any experience with insurance and if he can help you out. if he says he doesn't know what to do, call your insurance's grievance department and ask them exactly what they need from you to re-evaluate your situation. for physical therapy to be covered for me, after a denial, i called them up and they told me what they needed to hear from my PT. let us know if it helps! gina > > Well - I heard back from the insurance company (Anthem) and they are > denying surgery saying that it is not medically necessary. The > bastards ;-) > > They say there is no medically documented issues of chewing, > swallowing or sleeping problems? Apparently the fact that my teeth are > wearing away and I constantly bite my tongue and cheeks is irrelevant... > > Does anyone have any suggestions on how to appeal a denial? Any > suggestions would be much appreciated. > > -Thanks! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2005 Report Share Posted January 7, 2005 Hello, I also have Anthem and they also denied my surgery saying the exact same thing. They said the surgery isn't medically necessary and that there is no medically documented issues of chewing and/or swallowing problems. I called my OS office today and they said he would write a letter of appeal. Keep me up to date and let me know how your insurance process is going...thanks. -nate > > Well - I heard back from the insurance company (Anthem) and they are > denying surgery saying that it is not medically necessary. The > bastards ;-) > > They say there is no medically documented issues of chewing, > swallowing or sleeping problems? Apparently the fact that my teeth are > wearing away and I constantly bite my tongue and cheeks is irrelevant... > > Does anyone have any suggestions on how to appeal a denial? Any > suggestions would be much appreciated. > > -Thanks! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 9, 2005 Report Share Posted January 9, 2005 Hi guys, I also have Anthem (BCBS), and they denied my surgery for exactly the same reason. I will be paying out of pocket for my surgery. They even denied my initial OS visit (for evaluation). I appealed that, but the appeal was denied. I talked to the insurance lady at my OS's office, who said that from her experience, it would be very difficut to cover somebody like us, where all the potential problems are long-term, and not immediate. I decided not to waste my time on appeals. Which is not to say that you should do the same. But just know that it will be a very tough fight. Good luck. > > > > Well - I heard back from the insurance company (Anthem) and they > are > > denying surgery saying that it is not medically necessary. The > > bastards ;-) > > > > They say there is no medically documented issues of chewing, > > swallowing or sleeping problems? Apparently the fact that my teeth > are > > wearing away and I constantly bite my tongue and cheeks is > irrelevant... > > > > Does anyone have any suggestions on how to appeal a denial? Any > > suggestions would be much appreciated. > > > > -Thanks! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 9, 2005 Report Share Posted January 9, 2005 Not the best idea to cave after one denial, unless you're wealthy enough to foot the bills without missing the money. In which case, congrats to you and your forebears! yes. it can be a tough fight. But hey -- you're paying (I presume) for insurance coverage -- and I'd be pushing them to the limit. It's not as if you're making up some phony illness or injury. I would wager that, if you truly need this surgery, you have some problems about grinding, headaches, joints, etc... With my policy, I can ask for a review by a panel of oral and maxillofacial surgeons. I suggest that you do likewise. Those are the folks who are most likely to understand the issues at hand. C. > > > > > > Well - I heard back from the insurance company (Anthem) and they > > are > > > denying surgery saying that it is not medically necessary. The > > > bastards ;-) > > > > > > > > They say there is no medically documented issues of chewing, > > > swallowing or sleeping problems? Apparently the fact that my teeth > > are > > > wearing away and I constantly bite my tongue and cheeks is > > irrelevant... > > > > > > Does anyone have any suggestions on how to appeal a denial? Any > > > suggestions would be much appreciated. > > > > > > -Thanks! Quote Link to comment Share on other sites More sharing options...
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