denied.......feel like I got gut punched

samantha209 · May 27, 2011

someone posted an appeal letter on here before...I think I saved it on my home computer in case I needed it. Or try searching appeal and see what comes up. I believe it was in the Insurance forum. Good luck!

Tiffykins · May 27, 2011

Peer to Peer review with a letter of support from your PCP or whichever doctor manages your use of NSAIDS.

Griselda · May 27, 2011

A lot of insurance companies automatically deny and hope that you will back off. DON'T. I have had to write many letters when being denied for surgery (not this, because it is excluded) but, for instance, my son had heart surgery and had an extra tooth in the roof of his mouth and they didn't want to pay for him to be under general anesthesia, they wanted him tied to a papoose board while they pulled a tooth, Um, no, he was not even three years old. I wrote a pretty detailed letter, you have to put in 'catch phrases' that they are looking for, 'history of arthritis with a need for prescribed Indocin and daily over the counter nsaids (hey, they don't know you don't take these, as they are not prescribed), You shouldn't have to have both stomach problems and a need for these meds, so, you should be alright with just having that. It doesn't have to be a 'book' my letters are usually about one page long, just state that you realize that arthritis normally worsens with age, and that since you already take XYZ milligrams of blah blah, you do not want to find yourself in a position of needing increased dosages as you age and finding that you cannot alleviate your pain due to not having the recommended surgery for your pre-existing arthritis, blah blah. I've usually gotten an approval within a week once I've submitted letters. LIke I said, they are counting on people giving up, DON'T!!!