Insurance coverage is a contract

I have read a lot of your posts tonight, and am struck by how little is mentioned about the contractual issues. The big reason for denials right now is the "diet requirement". If you read your policy/plan, I can almost guarentee there is no mention of a diet requirement. The only exception I know of is Aetna, which posts it's requirements on its website. The rest of you need to appeal on that basis...that the requirement is extra-contractual. Of course, the insurance company will come back and say that you don't meet the definition of medical necessity. You need to show how you do meet the requirements for the NIH and the Milliman and Robertson guidelines. Writing an appeal is much like writing a "position" paper in college. You have to make your thesis statement and then support it factually. Fight the good fight! Roberta