Question:
Jst denied for Abdominoplasty need appeal letter
— michaela (posted on October 9, 2003)
October 9, 2003
Look at the question below (#245 right now), titled in LARGE CAPITAL
LETTERS "Here's how I got my reconstructive surgery approved" or
something like it. If you follow this persons advice I don't see how you
could lose on your appeal. This person has put ALL of the info you'd need
to get reconstructive surgery approved on ALL body parts.
— bufordslipstick
October 9, 2003
P.S If you don't get to read this in time before the question goes into the
library, I feel you could pull the question up if you looked under the word
"reconstructive".
— bufordslipstick
October 9, 2003
I just won a panni w/abdominoplasty appeal today. Please e-mail me and I
can send you the information I sent to my insurance company.
— Stephanie B.
October 9, 2003
Before you use someone else's sample letter....know what your policy says.
I used a sample letter and if I knew then what I know now, I would have
composed something entirely different. My mistake on my first letter were
many,1)didn't have medical necessary letters from doctors (got them for my
2nd appeal)2)Did not get offical diagnois of back pain and abdominal pain
from my PCP and treatment other then wearing a binder. 3)Can not grow a
rash now to save my neck and just said I was using OTC meds - big mistake -
wasn't costing them any money. Was denied twice for reason not covered in
policy - had an appeal hearing and that denial upheld first 2 except now
they said I didn't prove medical necessary. What I received on 3rd denial
was their medical necessary guidelines for abdominoplasty &
pannilectomy. I request an external review (independent - IN law)and in my
request I am claiming I was unfairly denied because I was denied 2x because
they claimed not covered procedure but yet they have guidelines for medical
necessary for this procedure. Study your policy and make sure you have your
documentation before starting the approval process.
— bbjnay
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