United Healthcare - Denied - Abdominoplasty and Panni
Now it says I can start the appeal process... where do I begin? I called the surgeon's office and they told me to call and start and appeal... hello, don't I need them to help me prove why it's medically necessary? I had provided 6 months history from my pcp documenting rashes, etc... mri results showing bulging disks, notes from my chiropractor...
so frustrated and don't know how or what to do next.
so frustrated and don't know how or what to do next.
I would contact the insurance directly - and ask "Of everything that I sent you showing the necessity of this operation - what is it that you are missing but f you saw would make the difference?"
Then what ever they say would make the difference - get it and send back in. Ask them their exact criteria and how your information didn't meet it.
Often times you will find that there is nothing missing and there is NO reason for denial - in which case you get the persons name, extention, and time you spoke with them and include in your appeals letter that it was stated that you have already submitted the required information and to that there was nothing else required.
Surgery Date 1-29-09
Surgery Weight 317
Lowest Weight 175
Current Weight 195
Surgeon Goal 180
Personal Goal 165
Total lost since surgery 142 pounds!!
Surgery Weight 317
Lowest Weight 175
Current Weight 195
Surgeon Goal 180
Personal Goal 165
Total lost since surgery 142 pounds!!
Contact your insurance company and ask them what their criteria is for accepting coverage of these procedures. If they have documentation that they can provide you review this with your doctor and see if you can gather medical records that prove that you meet the criteria that they have outlined on their plan documents. There are certain plans that have specific clauses that state that they do not cover these procedures. You might even be able to Google your insurance company and see if this information is on the Internet. In any event they have an obligation to provide you with documentation of what their acceptance or denial criteria is. You might wnat to start with a phone call to them and porve on the reasons for denial. The appeal process should all be in writing.
Good luck on your appeal.