Privacy of Medical Data/medical equipment
Hi, We have a medical equipment request that insurance denied saying it is experimental/investigational. It is for an unusual therapy that is covered in the benefits, but this therapy requires me to travel 300 miles each way to receive service. There is no one else in network that offers this service so the doctor prescribed the machine any closer. The doctor filed a doctor to doctor and the insurance's doctor had his mind made up before the peer review was performed. Rejected. Any recommendations on how I should file my appeal? Any language I should specifically avoid? Any specific words I should use? Thanks!
Hello! My expertise is not great in durable medical equipment but I will tell you how I would handle this. Your therapy is covered but you need the equipment for the therapy correct? If this is the case. If an appeal is needed then request your medical records from the prescribing physician. Read over them well. Highlight any parts that you would like to draw there attention too concerning the need of this equipment. Also explain the distance that you would have to drive to receive the treatment at a facility. Appeals certainly do get more attention from more experienced individuals. I will also ask my sister about this for you. She has many years experience in medical billing and much more durable medical equipment experience than myself. I hope this helps you. Please feel free to let me know should you have any other questions.