View Full Version : Insurance appeal

01-04-2011, 02:38 PM
Hi Everyone, This forum has been such a blessing for my daughter and myself. She is 18 with a c-curve of approximately 60 degrees. We have recently decided it was time to start consulting with qualified spinal surgeons. We live in MA, so naturally we made an appointment with Dr. Emans. Wonderful reputation, wonderful facility except that our insurance co. has denied our request for her surgery to be done in Boston. Instead they gave us the name of a general surgeon who does do scoli sugery but is not a spinal specialist. We will not use him, period. Has anyone been denied by there ins. co.? We are appealing the ruling. Does anyone have any advise, key words, documentation we can add to the appeal? Thanks for any help you can provide. Jacquie

loves to skate
01-04-2011, 06:46 PM
Have you asked her primary care doctor to help you with the wording of your appeal? How can an insurance company even think that a general surgeon could do scoli surgery? You daughter needs to have a surgeon who does only scoli surgery and Boston should be the best choice for that. Where in MA do you live? You must have an HMO insurance. Insurance companies don't have a clue what is involved with scoliosis surgery. My insurance company couldn't or wouldn't tell me what surgeons do scoliosis surgery. I had to find my surgeon on my own. I was blessed.
Good luck with your appeal. I'm sure you will succeed.

01-04-2011, 09:54 PM
I assume that you have an HMO policy, which essentially means that you give up your rights to choose your own medical professionals. I would personally wait until the next open enrollment, and opt for a more expensive PPO plan.

01-05-2011, 02:21 AM
hi Linda
don't know what PPO's cost out on west coast...
i am now paying $400 a month per person (for more than one person) for my HMO here on east coast!

i don't know that many who can afford PPO...especially for families!


01-06-2011, 02:24 PM
I think I would ask the surgeon you want to use if his office can help you with your insurance appeal. They usually have staff trained to work with the insurance cos. and may be best able to explain why you need his expertise. Good luck!