Appealing a Denied Insurance Claim
Appealing a Denied Insurance Claim
It can be pretty aggravating when you submit a claim for reimbursement for your medically necessary wig just to find they’ve denied your claim. Their decision may not be final and you have a right to appeal. These are the steps you should take if you find yourself in that situation. Medically necessary wigs should be reimbursed! The Steps:
- Educate yourself with your insurances coverage policy. Read the contract and be familiar with it.
- Understand the wording that might make your wig qualify or not qualify. A claim for a wig likely won’t qualify, a cranial prosthesis likely will. Perhaps there is other terminology (some use the term prosthesis device or other wording) that you should or shouldn’t use. Read the contract carefully and thoroughly.
- Send your original claim to the Medical Review Board and ask that they review the decision.
- Educate yourself on the medical codes and diagnosis codes; ask your doctors for help with this to ensure the correct codes were used. Be certain that your doctor included very specific details of the medical condition that has caused your hair loss.
- Find out the name of the head of the Claim’s Department, send your appeal directly to them and request a response.
- Include a personal note on why the cranial prosthesis is necessary. Include before and after photos to show the wig is not for cosmetic purposes. Talk about how the hair loss has affected you, whether it is social, financial, or emotional reasons.
- Keep copies of all documents, receipts, and such. Keep a record of any calls you’ve made, who you spoke to and the basics of the conversation.