Question:
Appealing Ins. Decision: How best to handle?

One month since hernia surgery which stretched my abdomen out more. Cannot wear same pants, some other clothes. No rash/fungal infection yet. Excess skin pulls down where mesh (hernia repair) sits. I've just got to get this approved! Any suggestions? THANKS A LOT!    — Cynthia M. (posted on April 12, 2004)

April 12, 2004
On what grounds were you denied? Have you contacted the insurance co about their medical necessary guidelines for the procedure? First time I submitted approval for TT I was denied on grounds of not covered. I appealed and lost through whole process and in final denial I was denied because I had not proved medically necessary. Also in the final denial was their Medical necessary guidelines for the TT! I then followed the guidelines and got my back pain documented (went to a Physatrist 2 times and did 4 PT sessions) Submitted for 2nd time for approval and was approved in 6 days. Good luck
   — bbjnay