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
Posted by daise (Member # 13622) on :
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 Posted by Aniek (Member # 5374) on :
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.
Posted by bettyg (Member # 6147) on :
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! Posted by on :
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