Guest guest Posted January 7, 2005 Report Share Posted January 7, 2005 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 8, 2005 Report Share Posted January 8, 2005 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 Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.