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Re: letter to insurance company for an appeal

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if you read the many threads titled " insurance... " yes it is very

common to get denied the first time. i think, so far, it sounds like

90% of us have!! let your OS handle the situation, i wouldn't get

involved unless you have a second denial. it is a HEADACHR to deal

with insurance, and i'm sure your OS is experienced in the appeal

proccess. and to approve your surgery, they need medical

documentation- not a plea from you on why you think you need the

surgery. so i would wait and let your OS handle it

gina

>

> My insurance company denied my first request for pre-authorization

> of lower jaw surgery. I've already started the orthodontic process

> so I'm a little concerned. I talked to my OS today and they said my

> OS will write a letter of appeal. The denial letter stated

> that " [my insurance company] requires documentation in the medical

> records of difficulty chewing or swallowing and these symptoms must

> have been present for at least four months for appropiate patient

> selection. The documentation received did not meet the required

> criteria. Therefore, this request cannot be approved. " Is this

> first denial common for other patients out there? Would it help if

> I wrote a letter to the insurance company also? Thanks for your

> advice.

>

> -nathan

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I got denied several times before approval. My orthodontist wrote

at least 5 letters to my insurance company stating the need along

with my oral surgeon writing a letter. From what I have heard in

otehr cases and even from the INsurance specialist at my doctors

office is that the insurance companies give you a run around hoping

that you will just give up and pay for it yourself. Keep at it

though you will eventually get it.

Rebekah

>

> My insurance company denied my first request for pre-authorization

> of lower jaw surgery. I've already started the orthodontic

process

> so I'm a little concerned. I talked to my OS today and they said

my

> OS will write a letter of appeal. The denial letter stated

> that " [my insurance company] requires documentation in the medical

> records of difficulty chewing or swallowing and these symptoms

must

> have been present for at least four months for appropiate patient

> selection. The documentation received did not meet the required

> criteria. Therefore, this request cannot be approved. " Is this

> first denial common for other patients out there? Would it help

if

> I wrote a letter to the insurance company also? Thanks for your

> advice.

>

> -nathan

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