My new Insurance rejected my IV claims...Need help

Discussion in 'Fibromyalgia Main Forum' started by bandwoman, Mar 9, 2007.

  1. bandwoman

    bandwoman New Member

    Hi everyone,

    I don't usually post on this board. I have been on IV therapy for 2 1/2 years for my FM and it has helped me to keep functioning in my teaching job.

    My new insurance which was supposed to process our claims in the very same was as the old company has rejected my claims as medically unnecessary.

    I need to compose a letter of appeal. Does anyone have any experience in matters such as this.

    These IV are a type of Myer's Cocktail. How many of you have this type of treatment and is paid for my your insurance?

    Any help would be greatly appreciated. I have to compose this letter very quickly as it affects my medical flex account which is ending at the end of March.

    Thanks.

    Nancy
  2. kjfms

    kjfms Member

    Medical necessity is based on the diagnosis and the code that goes with it your physician conveys to the insurance company. What was the diagnosis and code he gave them?

    I was a medical coder I will see if I can spot something.

    If he does not give a diagnosis that the insurance deems medically necessary according to their rules not sure what you can do. Basically it comes down to his diagnosis -- sorry I know that is not a lot of help and wish I could be more.

    Have you physician write the letter. Who is the insurance company? His office should be appealing this not you.

    If I think of anything I will let you know.

    Best of luck,

    Karen :)
  3. bandwoman

    bandwoman New Member

    My IV's are in conjuction with a shot as well. The total cost is $190. As far as insurance codes everything was in tact there. There were acceptable diagnosis marked and everything was kosher. My previous insurance accepted these claims for 2 1/2 years.

    The strange part is this new company has been very inconsistent with the way they have handled these claims. They paid for two, rejected two and then even paid one after the two they rejected.

    I think the red flag was the consistency in which I have these IV's which is every other week. They have now pulled the plug on my chiro and muscle therapy and again the red flag was the number of visits I make.

    My alt. doc was a traditional MD for 15 years. He said insurance companies always pay for these IV's.

    The doctor sent a letter of explanation but then I have the right to appeal this decision. I have gone through my union rep and he bascially directs me to the head person of our school district who is in charge of the insurance.

    She said that this letter of appeal goes to the insurance co. but a committee of teachers and other staff make the final determination.

    Just because our previous insurance paid doesn't seem to make any differece. Here is the rub. They are claiming now that our previous insurance was paying claims that they should not have been so therefore this new company is in the right. Can you see the whole scenario. This new company wants the school districts account so badly that they are bending over backwards rejecting claims etc. so they can be the heros and save the district thousands of dollars.

    It is very frustrating but I am not naive. I am very tenacious and I will not give up with out a fight. The problem is withdrawing treatment from me has made my fatigue and pain worse and it is hard to fight when you are dragging your heals and still trying to work a full time job that requires an enormous amount of energy. I am a band director.

    I do thank you for your input. I will be composing this letter today. Thanks again.

    Nancy