Question:
What do you mean by first letter, second letter?

My surgeon has been doing most of the work. They called me and said that I was denied and I said I wanted to appeal. Is that concidered my first letter or second. I was denied a seond time and I appealed a second time. But is that concidered my third letter??    — Melise B. (posted on December 10, 2001)

December 10, 2001
Ok... when they denied you the first time, it was basically a denial of services. You then wrote your first letter of appeal (or your doctor did) and they denied that appeal. Now you have written your second letter of appeal and they should be responding to that appeal shortly. Depending on how many levels of appeals your insurance company has, you might be able to write another one OR go before a committee or board of people to state your case and hopefully get it overturned. The insurance company I used to work for (and I worked in the Appeals and Grievance Dept) had 4 levels you could take it through... 1st level was a decision made by the medical director, 2nd level was the same but with more documentation and research done, 3rd level was put before a committee of your peers consisting of 1 nurse, 1 psychologist and 3 people who had basically no medical knowledge about the situation and so could be very un-biased. The last level of appeal was to the chairman and the board of directors. Very few appeals went past the 2nd level and if they went to the 3rd level it was a 50/50 toss as to whether the appeal was overturned or denied again. Find out how many levels you have... you may want to consider hiring a lawyer as insurance companies don't like to get into legal battles that will ultimately cost more than the procedure you are looking for. Good luck!!!
   — Kellie Jo B.