APPEAL ADVICE TO INSURANCE CO.

Hello, I have been denied by my insurance co. and believe their decision to deny was based on a minor reason. I have followed all the criteria, and the criteria has changed from the initial list of requirements sent to my pcp. I have additional data for my appeal, however any or all info and/or suggestions to help with my appeal is appreciated. Thanks  smck_52

I'm not sure exactly what the problem is, so I'd like to know more to help you! I'd first look at adressing the reason for denial first, and use your PCP/surgeon's reasons for submitting for approval as a starting point, followed by excerpts and citations from literature supporting the reason. Good luck!

Exactly If the patient advocate did not see all that was required,why send it ? My advocate was not a help. But the intial criteria that was sent to my PCP was not defined the same as what the denial letter stated was needed. I have since gathered some info together with my PCP and also my heart dr.which looks good in helping my appeal. I was numb at first so had no direction. I am trying to give them what they are requiring but not happy the insur can change colors if they want to. So thanks for your reply. I see you are post-op and very interested in how its going along.I know everyone is different but I like to hear it all. Never know which one will pertain to me. I try to get to a support group in Tempe when I can. I was going this week but I got sick. I live down south AZ.k thanks

Have you been to the insurance,cash pay forum? I found alot of helpful information there as well as I used a letter someone had posted to appeal my insurance denial. It seemed to really work. My pcp was very impressed and thought i had written it . Try that forum. Good info. And Good Luck.
Debbie

talk to Diana Cox in the DS forum - she is an attorney and an expert at insurance appeals and helps a lot of people with it . .

thanks I did get alot of help from the cash/pay forum I finally was approved on March 15 and my surgery is in 2 days April 11. I am getting excited and nervous. I will let ya know how it goes. Bye Sharon

Well Debbie I did not know about that forum, and I have been on it now for a few hours. My eyes are wiggen but I did get LOTS of helpful info. So thank-you so very much! I got sick this weekend, if I hadn't I would have sent what I had, now I am glad I waited. Kudos to you for your support! Sharon