DENIED.
Your treatment has been denied.
What should you do? |
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First, get a copy of your benefits booklet.
Second, get the denial in writing.
It's experimental/investigational
Experimental means whatever your insurance company says it means. Go to your benefits booklet, and study their definition of "experimental." Prepare to prove that your treatment meets and exceeds every requirement—paragraph by paragraph.
It's not medically necessary
"Not medically necessary" doesn't mean that the insurer took a serious look at your medical case, and determined that you don't need it. It means "we don't want to pay for it." Study the insurer's definition of medical necessity, make it your own, and prepare to turn it to your advantage.
It's out-of-network
So? If your insurer doesn't have a comparable treatment available IN their network, and your health will suffer without it ... you will be able to persuade them to pay for it. Prepare to prove that ...
... the in-network doctors are dangerously inexperienced.
... your expert-of-choice has documented good outcomes.
... what YOU propose costs less than what THEY propose.
Then, study my book and CD, and learn how to write a winning appeal.
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