Optima - Denied
Just got the letter back from my insurance company: Denied.
Denial codes: "D84F - Not medically necessary per Medical Director - Member responsible." "The requested service is considered investigational and not medically necessary per Optima Policy Surgical 78". What a surprise... :) |
Are you going to appeal?
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1 Attachment(s)
Romakis,
This may or may not help...see attached. Make the calls / letters anyway. It's a small effort that have a big ROI. |
Appeal
Yes, I am going to try to appeal. Thanks Harrison.
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Help
If anyone has any documentation to help me file an appeal, I would highly appreciate it. Please let me know and I will give you my e-mail address. Thank you all in advance!
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Quote:
"Dr. Peggy Ebinger, MD is a psychiatrist in Virginia Beach, Virginia." :clap::clap::clap: |
My appeal package
1 Attachment(s)
Sending the documentation today. Thank you all who helped me put it together (Jerry, Andi, thank you so much!!!).
Had a hard time finding an envelope to fit all the paperwork... :laugh::laugh::laugh: |
Wow, so the person making the decision was a freaking psychiatrist?! I'm entering into my own ADR denial hell, so this is good information to have.
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Appeal is also denied
1 Attachment(s)
As I expected, the appeal was denied as well by Optima Health. They stated that it was not "medically necessary", and that discectomy should have been used instead :jacks:.
I guess I should have cut the rest of my discs out, and leave everything else as is :jump:. Man, my appeal was so thick and looked so good :)... |
That really sucks!!! Sorry to hear...
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