Guest guest Posted January 7, 2004 Report Share Posted January 7, 2004 You should have your surgeon/dentist ask for an appeal as well, they get these letters all the time and should know what to write. Sample Appeal Letter I submitted my pre-certification letter for upper and lower surgery in November. I received a response saying that it was denied because " the treatment for malocclusion is specifically excluded. " My health insurance is United Healthcare. I am going to appeal it but do not know how or what to say. Does anybody have any sample appeal letters that I can look at that can help me? I checked this site and site 2 but could not find any. Any help would be appreciated. Thanks. _____ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2004 Report Share Posted January 7, 2004 I'm not expert on this, as I never had to appeal. And my surgeon wrote the request for precert for me. But what you do NOT need is a handy-dandy form letter, or one tailored to someone else's policy. (I don't know about United Healthcare, but BC/BS varies tremendously, state by state.) First step is to ask your surgeon, or his office, to help you. He may have someone on his staff who specializes in handling insurance issues. That person can be your best ally, second only to your surgeon. Second step is to read your policy carefully, and see what it does and does not cover. DO NOT LIE. BUT, if it covers repair of congenital skeletal deformities, that may be the key. If it covers TMJ, or sleep apnea, that may be the key. It may also specifically exclude any of these things. You will probably need your surgeon's office's help to get the specific codes for these procedures. Then write your letter -- or if your surgeon will help, so much the better! Good wishes to you, Cammie > I submitted my pre-certification letter for upper and lower surgery > in November. I received a response saying that it was denied > because " the treatment for malocclusion is specifically excluded. " > My health insurance is United Healthcare. I am going to appeal it > but do not know how or what to say. Does anybody have any sample > appeal letters that I can look at that can help me? I checked this > site and site 2 but could not find any. Any help would be > appreciated. Thanks. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2004 Report Share Posted January 7, 2004 I'm not expert on this, as I never had to appeal. And my surgeon wrote the request for precert for me. But what you do NOT need is a handy-dandy form letter, or one tailored to someone else's policy. (I don't know about United Healthcare, but BC/BS varies tremendously, state by state.) First step is to ask your surgeon, or his office, to help you. He may have someone on his staff who specializes in handling insurance issues. That person can be your best ally, second only to your surgeon. Second step is to read your policy carefully, and see what it does and does not cover. DO NOT LIE. BUT, if it covers repair of congenital skeletal deformities, that may be the key. If it covers TMJ, or sleep apnea, that may be the key. It may also specifically exclude any of these things. You will probably need your surgeon's office's help to get the specific codes for these procedures. Then write your letter -- or if your surgeon will help, so much the better! Good wishes to you, Cammie > I submitted my pre-certification letter for upper and lower surgery > in November. I received a response saying that it was denied > because " the treatment for malocclusion is specifically excluded. " > My health insurance is United Healthcare. I am going to appeal it > but do not know how or what to say. Does anybody have any sample > appeal letters that I can look at that can help me? I checked this > site and site 2 but could not find any. Any help would be > appreciated. Thanks. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2004 Report Share Posted January 7, 2004 I'm not expert on this, as I never had to appeal. And my surgeon wrote the request for precert for me. But what you do NOT need is a handy-dandy form letter, or one tailored to someone else's policy. (I don't know about United Healthcare, but BC/BS varies tremendously, state by state.) First step is to ask your surgeon, or his office, to help you. He may have someone on his staff who specializes in handling insurance issues. That person can be your best ally, second only to your surgeon. Second step is to read your policy carefully, and see what it does and does not cover. DO NOT LIE. BUT, if it covers repair of congenital skeletal deformities, that may be the key. If it covers TMJ, or sleep apnea, that may be the key. It may also specifically exclude any of these things. You will probably need your surgeon's office's help to get the specific codes for these procedures. Then write your letter -- or if your surgeon will help, so much the better! Good wishes to you, Cammie > I submitted my pre-certification letter for upper and lower surgery > in November. I received a response saying that it was denied > because " the treatment for malocclusion is specifically excluded. " > My health insurance is United Healthcare. I am going to appeal it > but do not know how or what to say. Does anybody have any sample > appeal letters that I can look at that can help me? I checked this > site and site 2 but could not find any. Any help would be > appreciated. Thanks. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2004 Report Share Posted January 7, 2004 I have UHC as well and after a long 6 month battle they finally approved me. I also suggest going this route as well - read your plan from front to end - this is how I got it covered - however my plan covered specifically " reconstructive surgery " and I used that angle in my appeal letter - use the letter your surgeon wrote to support your letter against what they do cover - just make it sound that what is surgeon wrote to them is what they really do cover - be professional and use medical terms when you can. > > I submitted my pre-certification letter for upper and lower > surgery > > in November. I received a response saying that it was denied > > because " the treatment for malocclusion is specifically > excluded. " > > My health insurance is United Healthcare. I am going to appeal it > > but do not know how or what to say. Does anybody have any sample > > appeal letters that I can look at that can help me? I checked > this > > site and site 2 but could not find any. Any help would be > > appreciated. Thanks. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2004 Report Share Posted January 7, 2004 I have UHC as well and after a long 6 month battle they finally approved me. I also suggest going this route as well - read your plan from front to end - this is how I got it covered - however my plan covered specifically " reconstructive surgery " and I used that angle in my appeal letter - use the letter your surgeon wrote to support your letter against what they do cover - just make it sound that what is surgeon wrote to them is what they really do cover - be professional and use medical terms when you can. > > I submitted my pre-certification letter for upper and lower > surgery > > in November. I received a response saying that it was denied > > because " the treatment for malocclusion is specifically > excluded. " > > My health insurance is United Healthcare. I am going to appeal it > > but do not know how or what to say. Does anybody have any sample > > appeal letters that I can look at that can help me? I checked > this > > site and site 2 but could not find any. Any help would be > > appreciated. Thanks. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2004 Report Share Posted January 7, 2004 I have UHC as well and after a long 6 month battle they finally approved me. I also suggest going this route as well - read your plan from front to end - this is how I got it covered - however my plan covered specifically " reconstructive surgery " and I used that angle in my appeal letter - use the letter your surgeon wrote to support your letter against what they do cover - just make it sound that what is surgeon wrote to them is what they really do cover - be professional and use medical terms when you can. > > I submitted my pre-certification letter for upper and lower > surgery > > in November. I received a response saying that it was denied > > because " the treatment for malocclusion is specifically > excluded. " > > My health insurance is United Healthcare. I am going to appeal it > > but do not know how or what to say. Does anybody have any sample > > appeal letters that I can look at that can help me? I checked > this > > site and site 2 but could not find any. Any help would be > > appreciated. Thanks. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 8, 2004 Report Share Posted January 8, 2004 I did remember one tip my surgeon gave me for an appeal in a different matter: With BC/BS here, at least, you can request a review by a panel of oral and maxillofacial surgeons. That may help, if it is possible. It worked in the appeal I asked for in that other matter. Those guys the O&MF surgeons) are more likely to know about these procedures than is an ordinary GP MD. Good luck. Cammie > Thank you all for the info. I did contact my benefits department > here at work, and they said that they are still revising their UHC > handbook for 2004 and should be ready next week. I work in a law > firm and one attorney is making revisions on what is covered and > not. Why the lawyers and the benefits people are doing it and not > UHC is beyond me. But I will read it top to bottom and use > everything I can. I will also have my ortho write a letter. I see > him on the 21st. I will fight til the bitter end. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 8, 2004 Report Share Posted January 8, 2004 I did remember one tip my surgeon gave me for an appeal in a different matter: With BC/BS here, at least, you can request a review by a panel of oral and maxillofacial surgeons. That may help, if it is possible. It worked in the appeal I asked for in that other matter. Those guys the O&MF surgeons) are more likely to know about these procedures than is an ordinary GP MD. Good luck. Cammie > Thank you all for the info. I did contact my benefits department > here at work, and they said that they are still revising their UHC > handbook for 2004 and should be ready next week. I work in a law > firm and one attorney is making revisions on what is covered and > not. Why the lawyers and the benefits people are doing it and not > UHC is beyond me. But I will read it top to bottom and use > everything I can. I will also have my ortho write a letter. I see > him on the 21st. I will fight til the bitter end. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 8, 2004 Report Share Posted January 8, 2004 I did remember one tip my surgeon gave me for an appeal in a different matter: With BC/BS here, at least, you can request a review by a panel of oral and maxillofacial surgeons. That may help, if it is possible. It worked in the appeal I asked for in that other matter. Those guys the O&MF surgeons) are more likely to know about these procedures than is an ordinary GP MD. Good luck. Cammie > Thank you all for the info. I did contact my benefits department > here at work, and they said that they are still revising their UHC > handbook for 2004 and should be ready next week. I work in a law > firm and one attorney is making revisions on what is covered and > not. Why the lawyers and the benefits people are doing it and not > UHC is beyond me. But I will read it top to bottom and use > everything I can. I will also have my ortho write a letter. I see > him on the 21st. I will fight til the bitter end. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 8, 2004 Report Share Posted January 8, 2004 Thank you for that tip. I just might try that. > > Thank you all for the info. I did contact my benefits department > > here at work, and they said that they are still revising their UHC > > handbook for 2004 and should be ready next week. I work in a law > > firm and one attorney is making revisions on what is covered and > > not. Why the lawyers and the benefits people are doing it and not > > UHC is beyond me. But I will read it top to bottom and use > > everything I can. I will also have my ortho write a letter. I see > > him on the 21st. I will fight til the bitter end. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 9, 2004 Report Share Posted January 9, 2004 I missed this post, you might want to look at the sample letters on the geocities info website at http://www.geocities.com/orthognathicinfo/ click on INSURANCE FAQs in the lefthand sidebar. I never had to deal with insurance here in Canada, so that's why the site is a little bit light in that area. Good luck! > I submitted my pre-certification letter for upper and lower surgery > in November. I received a response saying that it was denied > because " the treatment for malocclusion is specifically excluded. " > My health insurance is United Healthcare. I am going to appeal it > but do not know how or what to say. Does anybody have any sample > appeal letters that I can look at that can help me? I checked this > site and site 2 but could not find any. Any help would be > appreciated. Thanks. Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.