Guest guest Posted January 11, 2005 Report Share Posted January 11, 2005 Hi Cammy, The issue with me is that my biggest symptom (locking jaw) involves a TMJ, and my policy specifically excludes any treatment for a TMJ problem. In such cases, based on my reading, you can't get the treatment covered, even if it is medically necessary. Not every policy excludes TMJ treatment, but mine does. I am lucky that I do have the money to pay for this (our local hospital has very reasonable rates), but I would personally encourage everyone to go all the way in their fight. I just didn't feel that in my case, the effort had good chances of a payoff. Irene. > > > > > > > > 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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