appeal

peeches35
on 11/12/11 12:12 pm
VSG on 04/03/12 with
anyone been denied, what was your appeal process did you do it your self or did the surgeon office do it my surgeon said he will do it but i want to send my appeal letter I wrote to the insurance company. I have(HIP) Health plan of New York
VegasLAbound
on 11/12/11 1:08 pm - Cleveland, OH
VSG on 10/05/11 with
Well I work to send appeals and insurance companies will only do peer to peer appeals. Meaning a physician to medical staff. You'd be surprised to see who's making decisions at th insuracne companies. My docs have spoken to ob nurses to appeal decisions regarding epilepsy. Like umm excuse me who are you to deny anything not related to your field. So you're more than welcome to send your letter or even speak to your determiner however the physician and his office should handle any formal appeals because you're usually given one chance and if that chance is again denied you have 30 days to file a written appeal. Don't take any chances I'm sure they're familiar with the dialogue and good luck i;m sure things will work out.
        
peeches35
on 11/12/11 1:43 pm
VSG on 04/03/12 with
I was told they was waiting to do a peer to peer
VegasLAbound
on 11/12/11 1:47 pm - Cleveland, OH
VSG on 10/05/11 with
let that happen & if there is a written appeal needed/done then you should be allowed to send your letter with the other documentation sent from your physicians office.
peeches35
on 11/12/11 1:51 pm
VSG on 04/03/12 with
i was denied because thet state that it is let me look a the  Initial averse Determination "not medically necessary" but yet my BMI is 42 that whats gets to me like are you say BMI of 42 is ok.