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Requesting assistance re: Insurance Appeal

Posted by Andrew S on 7/19/02 at 08:43 (090089)

As expected, my insurer, Independence Blue Cross of Pennsylvania denied payment for ESWT as 'experimental'. I am appealing the decision but seek other's input regarding inclusion of materials. I would like to provide the carrier with studies and any other materials to have this procedure declared reasonable and necessary medical treatment. I do plan to take this to the mat so everyone can eventually get what I have found to be the only procedure to help my condition. If anyone has any materials they could email me, please send it to (email removed). If you would prefer faxing it, please send it to 215 483 2170 or last, mail it to me at:
Andrew SPiegel, Esquire
3901-A Main Street
2nd Floor
Philadelphia, PA 19127

THanks and once I get together a solid appeal, I will keep my appeal letter and the materials for others.
Andrew

Re: Requesting assistance re: Insurance Appeal

David G. on 7/19/02 at 11:02 (090104)

I'm just about to do my appeal with Oxford Health Plans. One thing that i believe will be imperative is letters from previous doctors showing failure with conservative treatment. It's amazing, I've had 2 EPF's in one foot an one in the other, this is considered 'conservative.' please stay in contact with me at (email removed).

Re: Requesting assistance re: Insurance Appeal

David G. on 7/19/02 at 11:02 (090104)

I'm just about to do my appeal with Oxford Health Plans. One thing that i believe will be imperative is letters from previous doctors showing failure with conservative treatment. It's amazing, I've had 2 EPF's in one foot an one in the other, this is considered 'conservative.' please stay in contact with me at (email removed).

Re: Requesting assistance re: Insurance Appeal

Oliver L on 10/23/06 at 12:29 (214067)

Hi, if you're still around, did ever follow through on this (successfully)?

I am beginning the same process with Capital BlueCross of Pennsylvania. (I had ESWT this summer and was turned down for reimbursement last month.)

If you have any advice or a materials 'template' I would be very appreciative.

Thanks

Re: Requesting assistance re: Insurance Appeal

Andrew on 10/23/06 at 12:34 (214068)

I was sucessful. I wrote a long letter saying that I had tried everything before and nothing worked except this procedure. I enclosed the literature I had on the procedure at that time,and told them I would fight it to the end. They didn't pay the whole thing, but they did send me a chunk of it. Its been too many years to recall the amounts, but Dr. Zuckerman gave me some articles on the procedure. Its been at least 5 years since I had it done and I am still 95% cured as long as I wear my orthodics. Best of luck

Andrew R. Spiegel, Esquire
Two Bala Plaza
333 E. City Ave
Suite PL-14
Bala Cynwyd, PA 19004
---------------------------------------
( Phone : (610) 668-8600
2 Fax : (610) 668-8604
4 E Fax : (413) 502-4107
* Email : Spiegel at philadelphialawyer.com
Website: http://www.philadelphialawyer.com