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» LymeNet Flash » Questions and Discussion » Medical Questions » Appealing Insurance Denial of Coverage for Rx Meds

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Author Topic: Appealing Insurance Denial of Coverage for Rx Meds
bubbalyme
LymeNet Contributor
Member # 11652

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Hi All,

Has anyone had any success in appealing a denial of coverage by a health insurance company for medications for lyme, even after the doctor has submitted supporting documentation? Any tips or information out there would be much appreciated. We're currently trying to get the insurance broker to help, but I'm not very hopeful.

Thanks,
Bubbalyme

Posts: 128 | From Raleigh, NC | Registered: Apr 2007  |  IP: Logged | Report this post to a Moderator
daise
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I was turned down for each antibiotic prescription.

Here's what did it for me.

A doctor who actually works for the insurance company in administration and who is familiar with Lyme went in-person to the formulary department, each time I had a new antibiotic prescription.

Turns out, it's what they needed to dot their "i's" and cross their "t's."

Some people complain to their state insurance board. They have an appeals process. Insurance companies get scared when a patient does that.

Does your state insurance board have an outside appeals process?

daise [Smile]

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Aniek
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Member # 5374

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BettyG has an example letter to use with insurance appeals. I think it's somewhere on the general board and you should be able to search for it.

--------------------
"When there is pain, there are no words." - Toni Morrison

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bettyg
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hi aniek, thanks for the plug but it is TIMACA who wrote the outstanding letter of appeal.

it's all in my newbie package; last 25 pages cover things.

do a search find in it using EDIT, FIND, and type in TIMACA; hit enter

keep; hitting enter until you come to her APPEAL INSURANCE LETTER clearly marked!

good luck; i've not had hi-speed for 5 days so far behind reading! [group hug]

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