Insurance Denial/Appeal - Vascular Birthmarks Foundation Forum
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  #1  
Old 09-15-2004, 02:44 AM
Leah
 
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Default Insurance Denial/Appeal

I am looking for help to make a case with my insurance provider to overturn a laser treatment denial for a pws on my 3 year old's face between his temple and eye. Although it is a small pws (about the size of a quarter), we would still like to begin laser treatments. The specialist we went to said that it would cost $3,000+ per treatment if not covered by insurance. I am looking for help to convince the insurance company that it IS medically necessary. I have traditional BC/BS. Has anyone successfully appealed a pws that may not be "medically necessary"? By the way, we were also told by our doctor that it would eventually go away.
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Old 09-15-2004, 03:12 AM
nickbar nickbar is offline
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Default Re:Insurance Denial/Appeal

PWS unfort. do not go away...Laser is a very good idea..as it does lighten it and keeps it from getting worse (you will have to continue with laser thru out his life).

Medically necessary, because some pws can cobble in adulthood.

CK OUT THE INSURANCE APPEAL INFO ON THE MSN SUPPORT GROUP PAGE>
for some reason the link will not post> i will try again in the next message.

Corinne
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Old 09-15-2004, 03:13 AM
nickbar nickbar is offline
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Default Re:Insurance Denial/Appeal

http://groups.msn.com/vascularbirthm..._whatsnew.msnw
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  #4  
Old 09-16-2004, 06:19 AM
alexasmommy
 
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Default Re:Insurance Denial/Appeal

Hi Leah. Corinne gave you a good link. You can also try http://www.birthmarks.com
They have a section about appeals, and even letters about the medical necessity of treating a PWS. I have heard from many people that they have to appeal before it is approved. Hang in there and fight them. It may not be a pretty road to take but in the long run, it is worth it.
Good luck and keep us posted.
Elena
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