I need positive information on dealing with insurance denials and how to have one overturned?
We have Blue/Cross and Blue Shield of Alabama that is through International Paper of Alabama. My husband is the subcriber and I am listed on the policy. I have a medical problem-Treatment Resistant Depression. There is a procedure that will help my condition very much and be less expensive for the insurance company. I donot understand why they deny something that would help me and save them very much money in the long run. Thank you for your advice!
Answers:
In order to get this paid, you'll have to almost think like a lawyer and put a case together, with documentation and expert opinion. Most insurers are inclined to say "no" first and quickly, so that they don't waste their time on "quack" treatments. However, this also means that they aren't creative in their thinking. Put together a solid case, and "sell" them.
Good Luck!
If you're talking about the device that's surgically implanted, good luck. Its still considered experimental by most health plans. If you do enough research & have enough help from your doctor, you may be able to get it approved. The more data you provide regarding the number of procedures performed in the US, and patient care/improvement since the procedure; the better. You want as much clinical information regarding long term patient outcomes & complications. Start looking online, and see what resources your surgeon can provide. Check with mental health organizations, like NAMI, or whoever. AND, go back to all your previous doctor's and request your records (or documentation stating you were being treated) You need to show how long and how much theraputic & pharmacological intervention you've exhausted. Then, you send it to the insurance company as an appeal, and tell them you wish to appeal their decision to deny you coverage for this procedure. Then, they have 30 days to respond. If they deny it, get MORE data & do it again. You may have the opportunity to request a 3rd review by a third party, who is not connected with your insurance or employer. good luck
If its a different procedure, I don't know. Same thing, but different clinical data.
Well, they should TELL you why they deny it - either they don't cover mental health, or they consider it experimental. Then you go back to your policy, and if it's the second one, it's much easier to get a couple doctors to argue that it's NOT experimental. But if they flat out don't cover mental health, you're out of luck. Then it's like you're trying to claim your car on your house insurance.
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Answers:
In order to get this paid, you'll have to almost think like a lawyer and put a case together, with documentation and expert opinion. Most insurers are inclined to say "no" first and quickly, so that they don't waste their time on "quack" treatments. However, this also means that they aren't creative in their thinking. Put together a solid case, and "sell" them.
Good Luck!
If you're talking about the device that's surgically implanted, good luck. Its still considered experimental by most health plans. If you do enough research & have enough help from your doctor, you may be able to get it approved. The more data you provide regarding the number of procedures performed in the US, and patient care/improvement since the procedure; the better. You want as much clinical information regarding long term patient outcomes & complications. Start looking online, and see what resources your surgeon can provide. Check with mental health organizations, like NAMI, or whoever. AND, go back to all your previous doctor's and request your records (or documentation stating you were being treated) You need to show how long and how much theraputic & pharmacological intervention you've exhausted. Then, you send it to the insurance company as an appeal, and tell them you wish to appeal their decision to deny you coverage for this procedure. Then, they have 30 days to respond. If they deny it, get MORE data & do it again. You may have the opportunity to request a 3rd review by a third party, who is not connected with your insurance or employer. good luck
If its a different procedure, I don't know. Same thing, but different clinical data.
Well, they should TELL you why they deny it - either they don't cover mental health, or they consider it experimental. Then you go back to your policy, and if it's the second one, it's much easier to get a couple doctors to argue that it's NOT experimental. But if they flat out don't cover mental health, you're out of luck. Then it's like you're trying to claim your car on your house insurance.
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