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Message started by kr1974 on Oct 31st, 2012 at 2:32am

Title: Re:Please Help! Suggestions for insurance appeal l
Post by kr1974 on Oct 31st, 2012 at 2:32am
I am in the process of writing an appeal letter to Blue Cross Blue Shield. They have denied my claim twice and this will be the final review. They denied my claim on my surgery for my nerve stimulator for occipital neuralgia, trigeminal neuralgia, and chronic migraines, stating that it was "experimental" and "not medically necessary". I was told by the doctors office that BCBS gave prior approval and prior authorization, which they did, and submitted partial payment, and than took it back. Has anyone had the same experience? Any idea's or suggestions? It was like teeth getting the neurosurgeon, who implanted the device to write an appeal letter. I can't seem to get any help from the hospital or clinic.

Title: Re: Re:Please Help! Suggestions for insurance appeal l
Post by BarbaraD on Nov 1st, 2012 at 12:30pm
The only thing I can suggest is to get in contact with your state insurance commission and raise hell.. (and do it in writing not on the phone). If they don't respond the first time... keep up with the letters and send them to Congressmen, Senators as well as state reps..

Did I mention that I HATE insurance companies with a passion!!!!!

Oh and READ your insurance policy real well.. there are always little loopholes in your favor if you can find them. But sometimes ya gotta look real hard and decipher what the BS means (or interput it to "suit" your needs - trust me.. you CAN do this if you really put your mind to it).

And don't take anyone's word for anything.. Get your "facts" together and argue your case the way you understand it. A lot of times they'll just get tired of you and give in (this from personal experience). But there will be something in that policy (in fine print) that will be in your favor ... take that and run with it and don't give an inch on it...

Good luck.. :-*

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