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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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#1
01-28-2015, 05:50 PM
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Insurance Appeals Package
Dear All,
In the process of preparing my first appeal. Would anyone be willing to share their appeals package so I can use it as a template/guide for mine? Even if you lost your appeal I am sure their are some great nuggets in yours that I can use. Please PM me! Thanks! TJ
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- Wife has been diagnosed with Severe Spinal Stenosis Right and Left Sides, Degenerative Disk Disease at C5/6 and C6/7, Large Osteophyte Complexes at a both levels, with C6/7 on R/H Side, and C5/6 both R/H and L/H Sides. Also Reverse Lordosis. - Performed 2-Level ADR with M6-C by Dr. Clavel, Barcelona Spine Center on 10/15/14. 
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#2
04-07-2015, 08:33 AM
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I have something stashed away
Hi TJ, Yeah, someone here sent me something a long while ago. I will try to dig it up. Basically the gist was 1. "Letter of Medical Necessity 2. Breakdown showing the Insurance co how much they would save vs. fusion 3. showing that it has been approved by the European FDA; thigns of this nature. There was also a case where a lady sued her I/C and won!
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54 yr old female 5'7" 147 lbs. non-smoker conservative treatments failed 2007 fusion @ C4-6 peek cages, failed due to long term use of cox-2 inhibitor 2008 revised C4-6 donor bone, plate & screws 2009 fusion with Roi-C @ C3-4 2015 MRI & CT mjr ddd @ C6-7, segmental kyphosis at C7-T1, 2-level M6-C prosthesis by Dr. Clavel Barcelona Spain 2019 H.O. formed behind M6-C @ C6-7 left nerve rt & in spinal canal. 2020 Revision C6-7 to a CP-ESP prosthesis by Dr. Schmitz Dusseldorf Germany
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#3
04-07-2015, 12:37 PM
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If you can send my way that would be great.
TJ
__________________
- Wife has been diagnosed with Severe Spinal Stenosis Right and Left Sides, Degenerative Disk Disease at C5/6 and C6/7, Large Osteophyte Complexes at a both levels, with C6/7 on R/H Side, and C5/6 both R/H and L/H Sides. Also Reverse Lordosis. - Performed 2-Level ADR with M6-C by Dr. Clavel, Barcelona Spine Center on 10/15/14.
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#4
04-13-2015, 06:54 PM
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I figured it out
Attachment 591
start with a simple claim. do not give more information than needed. do not assume you will be denied.
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54 yr old female 5'7" 147 lbs. non-smoker conservative treatments failed 2007 fusion @ C4-6 peek cages, failed due to long term use of cox-2 inhibitor 2008 revised C4-6 donor bone, plate & screws 2009 fusion with Roi-C @ C3-4 2015 MRI & CT mjr ddd @ C6-7, segmental kyphosis at C7-T1, 2-level M6-C prosthesis by Dr. Clavel Barcelona Spain 2019 H.O. formed behind M6-C @ C6-7 left nerve rt & in spinal canal. 2020 Revision C6-7 to a CP-ESP prosthesis by Dr. Schmitz Dusseldorf Germany Last edited by Cheryl0331; 05-12-2016 at 05:55 PM.
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