Insurance Denial

jettmom · #1 09-07-2006, 03:14 AM

My sons laser treatments just got denied by the insurance stating that it was a cosmetic procedure. Has anyone had this experience, or succeeded in appealing this denial? How do they sleep at night???

nickbar · #2 09-07-2006, 03:59 AM

Yes, this happens to a few people...there are people that win appeals.... THis site has information on handling insurance issues. Also, check out the vb support group on msn and msn back up site for examples of appeal letters that WON!

The key is to explain to the insurance co. why this is not cosmetic... PWS left untreated can darken. It is rare, but important to tell the insurance co. that pws can also thicken and cobble with age. Treated early on, the pws can be managed with more success.

here are the links to msn. YOu have to join the groups (I will approve you just let me know you have a pws or mention birthmarks in the applications).

http://groups.msn.com/vascularbirthm..._whatsnew.msnw

and http://groups.msn.com/VascularBirthm.../messages.msnw

missy · #3 09-07-2006, 11:22 AM

Hi there,

You need factual backup to win an appeal. Start with your physician's office.... the staff there deals with insurance companies all the time and they might know how to deal with yours.

Here is an example:
http://www.birthmark.org/appeal.php

This is good too:
http://www.birthmark.org/insurance_claims.php

There are other resources too, to help explain WHY this is NOT a cosmetic procedure:
http://www.birthmark.org/parents_publications.php

Also, look through http://www.birthmarks.com/Index.cfm since they deal with PWS. They should have some wonderful materials. This: http://www.birthmarks.com/Index.cfm?Page=28 deals with insurance.

Hope this helps out!

Missy

hankbartenbach · #4 09-07-2006, 01:58 PM

Hi,

I agree totally with Corinne and Missy. I just wanted to add one other thing. Being that I have had laser treatment for around 19 years now a letter from the doctor stating why your child needs this treatment or it can get worse, and poteintally cost a lot more down the road with surgeries left untreated.

Hope your appeal gets excepted.

Hank