Coverage was denied for a treatment that has been approved as medically necessary by the AMA and FDA. I wrote out a strong appeal letter, but who should I CC the letter to?
2007-11-05 03:47:35 · 3 answers · asked by Jess 5 in Business & Finance ➔ Insurance
You can CC it to anyone you like - I would send a copy to the doctor who ordered the procedure, the insurance comissioner for your state, and your HR person. (So that if others have the problem, they can opt out of renewing their contract with that plan)
That said, you can not force your plan to pay for something that is not a covered benefit. (I know of someone who tried to get speech therapy for her teenaged son, but her insurance does not cover it at all - not even for elementary schoolers. After appealing three times, she tried to sue them and lost.) But, you are completely within your rights to appeal it with proof that it is medically necessary in your case.
Good luck!
2007-11-05 09:54:50 · answer #1 · answered by zippythejessi 7 · 1⤊ 0⤋
It really won't make much difference, if you insurer does not cover the procedure. The fact that a procedure is medically approved and/or medically necessary doesn't change the terms of your coverage.
As an example, organ transplants, which are OBVIOUSLY medically necessary and approved, are not covered by many insurance carriers.
2007-11-05 04:27:13 · answer #2 · answered by acermill 7 · 1⤊ 0⤋
Your state insurance commissioner.
2007-11-05 03:54:39 · answer #3 · answered by Anonymous 7 · 2⤊ 0⤋