Need help with Med. insurance

[Paul H.]

About 2 months ago I filed a bunch of paper work to my health insurance co.
(Blue Cross Blue Shield Federal). The total charges were almost $2400. This was for numerous visits and a mouth splint. She had a severe case of Bruxism( teeth grinding). Now my insurance pays very little if anything for dental work which is what they consider this although her specialist doesn't because it can led to very bad consiquences to the jaw and surrounding muscles.
They ended up paying out just $600 and I wish to dispute this. How would I go about writing a letter to the insurance co. to help my case. I have never had to do this before so I am at a loss of how to word it. Thanks for any and all advise and help.

[bamachem]

call the insurance company and ask how you appeal/dispute a coverage decision.

[Paul H.]

I'll do that, thanks Andy.

[MTL_4runner]

Usually you'd need to get a copy of the insurance coverage policy and then prove your case as to why it they are wrong to have not covered you in your specific case. If you have a solid case, a few well written letters supporting your position should be enough for them to pay.

[Texas Jim]

What state are you in Paul??? Get your Doctor to write a letter saying why it is important to her health!! ie, studies and such showing how,

Get a copy of your policy and then send it with a letter from your self, the doctor, and the reason the insurance company, as to their denial. and copy everything. Then contact your States insurance commissioner and send them the info too.They will make the insurance company pay!!! TJ

[jrallan26]

Paul,
I work for an insurance company, and yes you need to call your carrier and inquire.

[bigwapitijohnny]

I would talk to your specialist who prescibed the splint and ask for a letter to the insurance company stating the medical ramifications of the dental problem. I am a dental specialist, and if a patient wanted me to write a letter on their behalf, I would without question. Just ask him/her to do it.

Regards,

BWJ

[Paul H.]

Well I called the ins. co. and they said to write a letter detailing why I want them to review the claim and send in a info. Her specialist told me to resend the original letter that I had already sent in and to specify that although he is not an in-network doc, they need to pay in-network rates because there are no in- network docs. in his field. I'm writing the letter this weekend.

[bigwapitijohnny]

Did you get a referral from your general dentist to see this specialist? If so, I would ask your generalist to 'ask' and have the letter written on your wife's behalf to send to the insurance company. That's a drag that you are having to re-send the original letter. :headscratch:

Good luck,

BWJ