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Insurance Hell All insurance-related matters are here: Medicare, worker's compensation, appeals, denials, insights, wins, losses. PRICING is here too. Note: This forum has posts from 2006 forward. Older ones are in the Big File.


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Old 01-12-2009, 10:05 PM
gclc1457 gclc1457 is offline
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Join Date: Oct 2008
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Default Help with appeal letter

My name is gary. I am a 39 year old male.i was recently denied coverage by united healthcare for single level (l4-l5) adr surgery. I have severe degenerative disc disease, and have been in pain for many years. It has become disabling over the last year. I have exhausted every possible conservative treatment. I have seen two spine surgeons who both agree that i would benefit best with adr surgery. Uhc states in my denial letter that adr is an " unproven service " under the plan.

I have done alot of research regarding this matter and would like to appeal there decision. I am not the greatest writer and would like to know if anyone has a copy or example of an appeal letter and a letter of necessity that they would be willing to e-mail me so that i could use it as a guide. I would greatly appreciate it if anyone could help.

Thank you to all and god bless!

GARY

Last edited by Harrison; 01-12-2009 at 10:15 PM. Reason: Email address deleted -- because of spambots
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Old 01-13-2009, 10:59 AM
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CindyLou CindyLou is offline
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Gary, welcome. I would get my hands on a copy of The Insurance Warrior, which is a book all about appeals. Do a search here up above and some information should pop up. It is an excellent resource. Best of luck to you!
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CindyLou
bicycle accident 6/19/01
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vertibroplasty @ above levels, 9/15/01
4/06 hip labral tear repair
4/07 Lumbar ProDisc replacement by Dr. B., 3 levels; L3-6
7/2/08 ALIF of L6-S1
7/30/08 Removed bone cement.
8/7/08 Diagnosed with pulmonary embolism, double pneumonia, collapsed left lung, pleurisy, pleural effusion.
3/10/09 right SI Joint Fusion; seeing light at end of tunnel, for first time in 8 years!!
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