Re: First Insurance Denial

[Guest guest]

Oh, pfui!

This can be the first step in a loooong and frustrating path.

First thing is, get yourself a calendar, an envelope file, and a

notebook. Put all the papers in there, and keep them where you have

them together and can get to them. With a pen for making notes, and a

notepad.

Then use them. Keep a record of every conversation you have with

anybody from the insurance company -- by telephone, in person, by mail,

by fax, whatever. Name of person, date, and message.

File an appeal. With my insurance, I am entitled to ask for review by a

panel of oral and maxillofacial surgeons. I hope you are, as well. In

any case, ask for that.

Anything further that you mail to them should be sent by insured mail,

certified and/or return receipt requested. Sometimes insurance

companies deny having received things, no matter how much evidence is

presented. But bear in mind that you are building a case, here. and you

need as much documentation as you can get.

Enlist your surgeon's aid -- and that of whoever handles insurance

claims in the office. Sometimes those folks can be godsends.

It isn't always a nightmare. My surgery was readily preapproved, and re-

preapproved.

But it sounds like the warning volleys have been fired over the bow, so

to speak. Stand up for yourself, and fight, fight, fight. They don't

quibble, I'll bet, before they cash your (and your employers') checks!

C.

>

> I just got my letter closing the request for pre-approval. The

> insurance is claiming they didn't get the records they requested and

> that they were closing the request. I'm pretty sure they got the

> records (letter of necessity, x-rays, etc.) because my OS had me come

> in to have those all taken in January for the authorization. I guess

> I will have to start over again and appeal. Does anyone have any

> experience with appeals? I am on Aetna, and I'm wondering if they

> said they didn't get records because the surgeon I have been seeing

is

> out of network. If anyone could tell me where to start for an

appeal,

> I would appreciate any info. Thanks!!

[Guest guest]

Sorry to hear about your first denial. I was denied a few months ago

and now I'm waiting to hear back from the insurance company about my

appeal. The problem with mine was they said they needed proof of

swallowing and/or breathing problems over the past four months. Does

anyone know where I get this type of proof and/or how I get around them

requiring this? This sucks because my braces have already been on for

about 3 months...do you have your braces on yet? Anyway, any help

would be appreciated.

-nate

[Guest guest]

Nate, I have had my braces already for 14 months. My surgeon's

estimate for surgery was this summer. I have an adjustment coming up

in a few weeks and looking for a time table at that appointment. I

wasn't asked for any proof on breathing or swallowing difficulty.

They just requested x-rays, letter of medical necessity, tracings,

bite registration, and things like that. I'm not sure what you would

need to do for that info. I am seeing an ENT for breathing problems

and actually having a surgery to correct a breathing issue before the

jaw surgery. Maybe an ENT could offer you some info on that.

Anyways, good luck with your appeal, hope it goes well! Also, Ceast,

thanks for all the great info. I am getting together all my info that

I've gotten so far and getting ready for the fight!! Thanks again!