Special Needs

Insurance Appeal Letter help please :o)

So after we took DS2 to Mayo in September, our insurance company denied coverage of one of the claims because they said it was "not medically necessary or experimental." So we call and try to get it recoded. Mayo said they couldn't do that bc then it might be considered fraud. (Apparently theres only one code for mr spectroscopy)

Okay. So I called the billing dept and she sends medical records to the insurance. She also gets the dr to send a letter stating the medical necessity of the test to us. Now we have to write our own letter to go along with the letter from the dr to send to insurance. We're really hoping to get this covered at least partially bc this one claim is $2000, it would cut out bill a lot. Who has any advice on what to put into our personal letter? I'm just at a loss for where to start, and I know some of you have been there. Thanks!!

Blake 04/29/05 Will 06/12/07 Baby Birthday Ticker Ticker

Re: Insurance Appeal Letter help please :o)

  • check your private messages
    Me 27, DH 30. Married Since April 2008. Not avoiding since 2009, TTC since 2010, started w/RE June 2011, Me: PCOS,insulin resistance, irregular cycles. Started Metformin June 2011. All tests clear me. DH clear with excellent tests results. BFN on all 5 Clomid cycles. BFP on IUI cycle #10, medicated #8,3rd inject w/Follistim and Ovidrel trigger July 2012! 7 days past IUI Prog and Est check 26 prog, 264 Estrogen. BFP 14 DPIUI, Beta #1 14 DPIUI = 140, Beta #2 16 DPIUI = 336!! 6wks 4 days saw baby, saw and heard heartbeat at 122! Daisypath Anniversary tickers Lilypie Pregnancy tickers BabyFruit Ticker
  • I read it. Thanks so much!! I hope they'll reconsider too. And yes it was helpful.
    Blake 04/29/05 Will 06/12/07 Baby Birthday Ticker Ticker
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