Re: Re: First denial - needing to appeal

August 11, 2005

Though I agree that doctors offices do a fine job at

their portion; I would encourage you to work the

appeal up as well. I had my claim denied at first, as

most people do. But by being proactive I think it ups

your odds of having your appeal granted. My surgeon

did his part by outlining the type of problems I had

due to my underdeveloped jaw, specifying the procedure

and insurance code, and making it clear that the

procedure is medical and not dental and necessary for

my health.

On my end, I researched my insurance documents so that

I could properly address their reason for denial. In

addition, I detailed my own difficulties due to jaw

malfunction (i.e. headaches, sore jaw, popping, etc.).

Then I gave a narrative time line of the steps I took

to get to oral surgery from dental diagnosis to ortho

to oral surgeon.

All in all, my appeal including the correspondence my

oral surgeon provided was ten pages. That also

includes exhibits pertaining to discrepancies in my

insurance policy. My point is that it's better to do

everything you can as if this was your last chance to

have your surgery approved. It will either save you

time on not having to deal with a second appeal or it

will become supporting documentation in that follow up

appeal.

Good Luck,

Holly

> Hello,

> Regarding the appeal process. For the initial

> appeal, I would let

> the doctors office handle it. That is what they do,

> so most of them

> do it right. Don't worry too much, it is very

> common to be denied

> the first time around.

> Braces off by December.........some people have

> gotten off that soon,

> but I wouldn't plan on it.

> Good Luck, a

>

> > I am a first time user to this site and love the

> supportive nature

> of

> > all of the posts. I am scheduled to go into the

> oral surgeon on

> 8/22

> > for measurements, models etc. and I just got my

> first denial letter

> > from BC/BS in Kansas City. I actually work for a

> hospital and they

> > don't have a surgeon here that does the surgery.

> Does anyone have

> any

> > wonderful advice about appeal letters, procedures

> etc.? I have let

> the

> > office manager handle the initial claim and don't

> know if I should

> > write the appeal myself or have the doctor handle

> it. I have to

> have

> > the lower jaw moved about 10 mm and am hoping to

> get everything

> done

> > the first of September.

> >

> > Also...how about an estimate of the time left in

> braces after the

> > surgery? I am extremely anxious to get these

> " wonderful " things

> off my

> > teeth! I turn 36 in December and eating cake

> without braces would

> be a

> > wonderful present! But, I think I am pushing it.

> >

> > Any advice would be helpful and much appreciated.

> > BKSwannaBe

>

__________________________________________________

August 12, 2005

holly -

thanks for the information. I am definitely leaning the way you went with your

process. It sounds like we are very similar. I also have an underdeveloped jaw

- the lower one - about 11 mm. I have started the " just in case " budget plan,

but I am really hoping for a positive outcome from the appeal. I would love to

read your appeal letter to get an idea of what to put into mine. you can always

send it directly to my email address if you would like.

Thanks again for the info!

Holly King wrote: