My company medical insurance has been pretty good about playing along with my Lyme IVs and Rx medications to this point. Today, I got my first "these meds are not approved" letter for my 2 week course of IV Invanz. They want to deny payment. Obviously, I'm going to appeal their call. I'd appreciate any letter writing tips about politely tossing the rock back their way. I've been on the policy for 12 years.
Thanks, GM
Posted by dmc (Member # 5102) on :
I'm not great at writing. I think th doctor who RXd it should be the one to explain it's medically neccessary.
Posted by dmc (Member # 5102) on :
up for others imput
Posted by Lymetoo (Member # 743) on :
I'm no longer good at writing either. I agree with dmc that your dr's office should make an appeal for you.
"Chest bump"????? I had no idea what this topic was about... finally decided to open it and see!! Posted by garunner (Member # 19474) on :
CALDA (Calif Lyme Disease Assoc) has a great form letter you can download for those appealing to insurance companies.
Posted by gridmonster (Member # 19280) on :
Thank you everyone. I'll let you know how this turns out.
Posted by gridmonster (Member # 19280) on :
Here is the link to the CALDA insurance denial form. I'll call my doc, and give this a shot as well.
My LLMD has taken care of denial for me in the past. The office knows all the technical jargon and is much better at justifying things than I am.
Posted by springshowers (Member # 19863) on :
This is good to know... I am thinking I will get one of those letters ....
And i was not sure how it can be handled..
So the doctors office is willing to and will take care of those denials for us??
Posted by gridmonster (Member # 19280) on :
I called my LLMD's receptionist. His staff said to have the insurance company's doctor call him. I called the insurance company doctor, his CSR said she'd pass along the request. Meanwhile my IV line is switched off due to the insurance paperwork roundy-round.
Posted by gridmonster (Member # 19280) on :
I finally got my insurance company's policy review doctor to call my LLMD. (It only took about 8 phone calls, seriously.)
For now, we're back on "I.V. Payments Approved" course.
Posted by Lymetoo (Member # 743) on :
WOO HOOO!!!
Posted by seekhelp (Member # 15067) on :
Do your LLMDs charge big bucks to perform this task? I mean trying to get insurance to pay for things they initially decline. Or is it a built-in service to the already big price tag paid?
Posted by gridmonster (Member # 19280) on :
I don't believe that LLMD charged me to call my insurance company doctor. He does charge for filling out long insurance / disability forms. (I really can't blame him for that.) Billable time, working is billable time. I guess I can't complain about my insurer, they've only question my treatment protocols once in 8 months.
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