Question:
Need help with first letter to insurance company
I need some help writing a letter to my insurance company, I am going to be submitting my claim on july 1 st. I want to be approved so bad (just like everyone else, I know)..... I want my letter to point out the risks of not having this surgery. and to show that my life would be much better if I had this surgery. You can find my info on Dr. Waltons patient forum. PLEASE would you share your letters with me. [email protected] is my email. I am desperate for help. — B D. (posted on June 20, 2003)
June 20, 2003
Hi, I just wanted to say that I never submitted my own letter to the
insurance, even though I wanted to because I felt it would help strengthen
my case. A co-worker who had the surgery a couple years ago advised me not
to, to just give them what they asked for. I took her advise, and when it
was requested that I have a psych evaluation to determine motivation and
compliance because my "comorbidities appear to be mild," I was
able to explain to the psychologist all the stuff I wanted to put in my
letter, stuff like having to use a wheelchair when I go to the store, like
waking up EVERY day in pain either from my feet, knees, back, or all of
them hurting; like the pain getting worse and worse as time goes on...
After my psych evaluation, I was approved less than a week later. Those
are all things I wanted to put in my letter, but I was able to express them
to the psychologist and he put it all in his report. Good Luck on getting
approval, and God Bless...
— Moysa B.
June 20, 2003
B, before you go writing letters to the insurance company, find out what
criteria they use to approve the surgery, IF it is a covered benefit.
Sometimes writing a letter is pretty much a waste of time, and the
insurance company doesn't really care how much you need the surgery and how
great your life will be after you have it UNLESS you meet their criteria!
Sometimes it can even backfire on you, so don't send in any letters until
you find that you need to. Also, your surgeon is the one who will be
seeking approval for the surgery, and it will be that person's
responsibility to send the information. I just don't believe the insurance
company will look at your letter and give you an approval without something
from the surgeon. It sounds like you are ready and enthusiastic about the
surgery, but slow down and let the process move as it should at this point.
You might need the info in the letter you want to send for an appeal later
on, so hold off for now.
— koogy
June 20, 2003
There is a lot of good information on this website for you to utilize.
There is a sample letter here that may help you. Go to the top of this page
and click "Your Journey", when you get to the next page look at
the links on the left andn scroll down to "Getting Authorization"
and click that, then when the next page populates look at the links on the
left scroll down to the white box that says, "Letter of Medical
Neccessity" and Voila!! Hope it helps.
— ToriJ
June 20, 2003
I forgot to mention one thing. After you click on my journey(at the top of
this page) the very next page you get you need go to the link that says
"Preparing for your Initial Consultation" click that and then
follow the other steps I mentioned. Sorry about that!
— ToriJ
June 20, 2003
Hi! I have my complete letter in my profile. It is very through and
detailed, and literally hundreds of people have used it and gotten approved
the first time around. I haven't heard of anyone that has been denied. All
you need to do is personalize it to your situation, and send it off! :~) If
I can help you, email me. I am more than willing to help any other AMOS
member! :~)
— Sharon H.
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