Re: Thoughts on getting past insurance denials

[Guest guest]

:

I had the same issues. Isn't it crazy that insurance wants to

consider

this (these) procedure(s) cosmetic or whatever? It really urked me.

My surgeon finally wrote a letter (a good one) that stated all the

reasons it was medically necessary and cc'd in all of my treating

doctors. It is documented in medical records when you complain about

things, which I had. The main reasons were my migraines and

headaches

and the fact that I could not eat/chew correctly and the pain! This

was all dramatized pretty good, but still. My surgery was almost 3

weeks ago and so far my bills are up to $73,000.00 for the surgeons,

the anesthesia, the hospital, and some attending physicians. It's

insaine. Keep working with it. I also know my surgeon stopped

calling

it orthognathic surgery, even though that's exactly what it is, and

called it something else. ??? I wish you so much luck because I

know

I more than likely wouldn't have had this done had my insurance not

paid.

I hope this helps a little - from K.C.

> Hello all

>

> I am trying to get my orthognathic surgery approved by my insurance

> company through my work. They have tried every type of denial

> possible from plan exclusions to medical necessity. Does anyone

have

> any advice on proving medical necessity to the insurance companies?

> Three surgeons and two orthodontists have told me that it is

medically

> necessary.

>

> Thanks

>

>

[Guest guest]

> > Hello all

> >

> > I am trying to get my orthognathic surgery approved by my

insurance

> > company through my work. They have tried every type of denial

> > possible from plan exclusions to medical necessity. Does anyone

> have

> > any advice on proving medical necessity to the insurance

companies?

>

> > Three surgeons and two orthodontists have told me that it is

> medically

> > necessary.

> >

> > Thanks

> >

> >

Hey i had the same problem when my insurance didn't approve but my

doctor had told me all he had to to was kinda tweek and rearange his

words a little bit and the they accepted. Now my insurace is gonna

cover my surgery so see if your doctor can do a little more.

[Guest guest]

, read around in the back posts. You might even want to do one of

those tedious searches through the archives. This has been a perennial

subject of interest.

There are posts here (I did one just recently, either here or on site

2) and there are sample letters on Fiddlesticks' geocities site.

Look at all that, and if you still have questions, maybe someone can

help you with an answer vis a vis your specific insurance group or

surgeon.

C.

> Hello all

>

> I am trying to get my orthognathic surgery approved by my insurance

> company through my work. They have tried every type of denial

> possible from plan exclusions to medical necessity. Does anyone have

> any advice on proving medical necessity to the insurance companies?

> Three surgeons and two orthodontists have told me that it is

medically

> necessary.

>

> Thanks

>

>