HealthAmerica -- refuse to pay for bar and shoes! (grumble)

[Guest guest]

Well I was just notified today that HealthAmerica is refusing to pay

for Jayson's shoes and bar, saying that's it's not covered under our

insurance.

The orthotics place called and let me know and stated that they would

work with me on the price, if we had to absorb the cost of them.

So, I am going to file an appeal with the insurance company. I was

wondering if any of you have examples of letters sent to appeal a

rejected claim.

Also, any other advice is greatly welcomed.

Thank you so much,

-BJ

[Guest guest]

Well I was just notified today that HealthAmerica is refusing to pay

for Jayson's shoes and bar, saying that's it's not covered under our

insurance.

The orthotics place called and let me know and stated that they would

work with me on the price, if we had to absorb the cost of them.

So, I am going to file an appeal with the insurance company. I was

wondering if any of you have examples of letters sent to appeal a

rejected claim.

Also, any other advice is greatly welcomed.

Thank you so much,

-BJ

[Guest guest]

I'm not sure how things work with HealthAmerica, but if you are putting

in an appeal, they may have different ways of doing it. My insurance

company (Medica) has several different ways of going about an appeal.

The one we've found to be the most effective is to have the doctor

write a letter about what the brace is used for, and why it is a

medical necessity. Then, if that doesn't work, there are usually

second level appeals. That's when you get to chose who reviews your

case (a board of non-doctors, a panel kind of like jury that you can

speak before, or a doctor). After that, I'm not sure what happens.

Also, find out why they don't cover it. It may be a coding issue with

the place you get it from, or it may be the place you are getting it

from. If they aren't a approved supplier, try to find out who may be

in your area. The insurance companies are wicked in all of their

little rules and loopholes.

Good luck!

> Well I was just notified today that HealthAmerica is refusing to pay

> for Jayson's shoes and bar, saying that's it's not covered under our

> insurance.

>

> The orthotics place called and let me know and stated that they would

> work with me on the price, if we had to absorb the cost of them.

>

> So, I am going to file an appeal with the insurance company. I was

> wondering if any of you have examples of letters sent to appeal a

> rejected claim.

>

> Also, any other advice is greatly welcomed.

>

> Thank you so much,

> -BJ

[Guest guest]

Hi I also wanted to say I agree & think the best first step is have

the doctor write a letter of medical necessity and/or call for you. I

would try to get it in writing though. The next think I would do is

ask for a case manager or nurse or someone who works for the insurance

company so you can just deal with one person for all

questions/approvals, etc. this gives you the advantage of having one

person to explanin to about clubfoot, etc.

Michele