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Tips for insurance appeals

Posted Jan 19 2012 6:20pm
I want to share some tips for insurance appeals. I'm not sure if they all help but I'm sure they can't hurt.

First of all, I don't know if this is true, but it seemed true for me. I was told that an appeal coming from a patient is often more successful than a doctor appeal. Your doctor should be able to appeal 3 times, and if all of those are denied, it becomes the patient's turn to appeal. What I did with mine was just overwhelm them with info. I wrote like a 6 page letter giving them a history of my headaches for the last 15 years, telling them all the things I tried,how it had affected my life, and why the stimulator was the last option. I wrote it as an essay so maybe it would make them think of me as a person instead of a number.

I also included references to current research articles. I suggest using Google Scholar to look for professional articles. I have a list of them that I'd be happy to share but I'm sure there are some more up-to-date articles available as well.

I also did a simple cost-benefit workup. I'm not much with numbers but I basically added up my costs for the past year, and estimated how much of that could be cut out if the stimulator works (75% of prescriptions, ER visits, urgent care visits, etc.) and compared it to the stimulator to show that them paying for the surgery would be to their financial benefit within as short as a year.

And lastly, I'm also it's told the diagnosis and procedure codes are important. For example, if your diagnosis is coded as "migraine" it won't be as successful as if it's coded as something more specific like "occipital neuralgia." I already posted the codes that were successful for me on here somewhere but if you can't find them, I would be happy to post them again.

Those are my tips. I hope they help. If anyone has anything to add, please do!
 Also, as previously posted, we've got a great group going regarding occipital nerve stimulation on Facebook so please join us! http://www.facebook.com/groups/232392623486874/


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