Denied AGAIN!!!!!....What Did I Do WRONG?????? HELP!!!!!

Hello,

When I was denied the first time by my insurance company, I wrote an appeal letter that I thought was fine.....WRONG!  Can someone PLEASE tell me what I did wrong!  According to my insurance company my revision surgery is not a medical necessity.  So, I elaborated on each co-morbidity and I thought that would be enough, but apparently it wasn't. What did I do WRONG????????
 
I want to appeal again and hopefully this time I will get the approval I need to have the revision surgery.  Does ANYONE have advice/suggestions/pointers on writing an effective appeal letter?  I need this revsion surgery like yesterday and I am so frustrated by this entire process.

PLEASE help!

Thank you!

Y.

Did your surgeon participate in your appeal? They probably need medical facts not just your reasons for needing it. Better yet call them and ask them what they want or are looking for. Is there and exclusion on your policy? If so they may never approve it, but the easiest way to give them what they want is to ask them exactly what they are wanting, tell them neither you or your surgeon understand what they want. I wish you the very best and a speedy approval. Insurance can be so picky!!!

Hello,

Thanks so much for responding!  I sent the appeal letter without any documentation from my surgeon and I guess that was my mistake!  I will definitely call my insurance company and find out what they are looking for and then I  will be in touch with my surgeon before I appeal again.  Thanks for the well wishes God knows I am going to need it.

Y.