Author Topic: Anyone written appeal to insurance for coverage?  (Read 1015 times)

Offline wvalum07

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Background info:

My insurance: Bluecross Blueshield has a medical policy saying they will cover gynecomastia correction if certain measures are met: mainly grading scale of gyno, weight equal to/less than BMI of 25 and no evidence of medical reasons for the gyno.

I am 30, have had gyno since 10 years old. I met with a plastic surgeon yesterday and he graded my gyno at 2-3 on the scale (which meets requirements), my BMI is 25 (meets requirements). So he is confident that it will be approved. I have no medical history, no medications etc...

However, when the office worker who deals with the insurance came in to get my info to submit to the insurance company, she bluntly said: "Expect them to deny it the first time." Apparently thats a common place thing. She said to go ahead and type of an appeal letter and have it ready to submit if a denial occurs.

So my questions: anyone have experience with an appeal letter that worked, what should I include?
Thanks!

Linkback: https://www.gynecomastia.org/forum/index.php?topic=29936.0

Offline wvalum07

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Perhaps any doctors have experience with their patients going through an appeal with success?

Offline Zenxer

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I have heard of stories where people did get the insurance to cover their surgery. Most of the time insurance won't cover it though. It's worth a try! Good luck.
My surgery was done on Oct 20th, 2014 by Dr. J. Craig Fielding in Toronto, Ontario.


 

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