Question:
When appealing to ins co, what should be included besides the letter?

This is my first denial due to an exclusion in the policy. However, in the Plan Summary the Company states they will make decisions on a case by case basis. First appeal goes to ins co (3rd Party Admin) and then if they deny again it goes to my Company for appeal. What should I include? Should each appeal contain something different? Any examples available? Thanks so much for your help!!!!    — T W. (posted on March 26, 2002)

July 13, 2003
I had been denied coverage from Mutual of Omaha. It was a very distressful situation, but I have to say that after my first appeal, they approved coverage. It is very important to be persistant. They need to understand that you are serious about getting coverage and that you are not going to just "go away". You are paying them for a service and it is their responsiblity to live up to their end of the bargin. It is also important that YOU understand that YOUR getting approval is only important for you. The insurance company IS NOT YOUR FRIEND. Your approval is nothing to them. It is only important to you and those that care about you. They don't. For them, this is business. For you, it is personal. Request that your doctor support your appeal by providing more indepth information to the insurance company. It would also be nice if he or she called and spoke with them. My doctor was very supportive and did both of those things. That really made a difference. And last, but not least, read the most current Yearly Brochure from the insurance company and ensure that you meet ALL of the requirments. If you don't have a manual copy available, there is a copy on their website. If you do this, there is no way that they can legitimatly deny coverage. Sometimes you have to go the "extra mile". I contacted the FDA in reference to the LAP procedure because that was part of their initial denial. Don't be afraid the challenge their decision.
   — Ce-Ce P.