I Knew it.....DENIED!

[Heller2u 11]

Well, I just checked my mail and there it was, the news I had a feeling was coming. DENIED!

The reason given appears that they don't have enough documentation of the 6 month PSWL. I'm trying not to panic and I think I can supply them with what they want (I have several weeks of food journals, the printed 1200 calories a day guidelines from my doctor, the exercise handout, but I think they're looking for it to be stated on the notes from the 6 visits and it's not there. Any help or words of wisdom?

[DoOver 17]

Do you have company insurance? I'm wondering if you know anyone personally who's been approved by your plan who can guide you.

[Khy 16]

Have your insurance coordintor contact them and ask specifically what is missing. That way you can give them what they want and don't have to use up all your appeals.

Khy

[Heller2u 11]

How many appeals am I allowed to have?

[AnneG 7]

How many appeals am I allowed to have?

You would need to ask your insurance company how many appeals they offer but I'm aware they often they want the info within a specific time framelike as an example 10 days - to add to current request but as an example- 30 days with an appeal. Every insurance company is different those examples are for mine insurance company.

Stay strong and focused even if it takes a bit of time. Keep us updated. Hope all goes well.

[KristinaRN 54]

I was denied, for the same reason. This was on a Friday. I called that afternoon, and they said they would pass it on to the supervisor, because all of the required info WAS there. I got a call that next Monday morning that it was approved! I did not have to go through a formal appeal process, just called and stood my ground that I KNEW it was all there. Sometimes I think they deny you at first, hoping you will move on, but if you are firm and push back, they will usually approve if all requirements have been met. Good luck!!!

[Heller2u 11]

I'm going to appeal with everything I have. I can't change any documentation (or lack of) from my PCP, but I can offer them several weeks of food journals and plans supplied to me by my PCP. I feel like my insurance coordinator hasn't been very informative to me, I have tried to keep in touch with her during the 6 months and I asked her what exactly I was supposed to be doing during the time, she didn't tell me to make sure my PCP was documenting certain things. oh well, can't change the past, just going to fight with all my might to get the insurance company to see things my way.