Need help fighting insurance company

Discussion in 'Fibromyalgia Main Forum' started by kar1953, Sep 3, 2003.

  1. kar1953

    kar1953 New Member

    In Feb. my doc prescribed a TENS unit for me. A couple of months ago my ins. co. decided to deny me the unit. In other words, if I want it, I have to pay for it myself. So I appealed their decision. This past Sat. I got another letter from them denying it again.

    They say "there is no substantiation in the peer reviewed medical literature that the use of a TENS unit is restorative or the treatment of choice for a reported diagnosis of fibromyalgia."

    I plan to search pro healths library for articles stating that the TENS unis is a choice of treatment for fms.

    I'm asking any of you who know of any articles stating this to please let me know where to find them. I just spoke to my ins. co. & they said if I can add additional info supporting my request they would review it again. She also said I can appeal as many times as I want as long as I introduce new info. each time.

    I sure will appreciate any help anyone can give me. Since I had that accident last week, I've gone downhill so quickly, am in much pain, saw doc today & he put me off work till Monday.

    The only thing that made it possible for me to work this past week was that TENS unit & now they want to take it away from me. I'm sure the stress of the accident, the pain & the stress of these denials is not helping me recover from this major flare I find myself in.

    Thanks & take care......Kathi
  2. pam_d

    pam_d New Member

    ...not familiar with tens units myself, but I've heard them mentioned often here----hope someone who uses one knows of supportive documentation, or perhaps their doctors might!

    Pam
  3. Mikie

    Mikie Moderator

    Your doc needs to write a letter to the ins. co. stating that the Tens unit it medically necessary. That is the catch phrase, medically necessary. If you are persistant in your grievance process, you will usually prevail with insurance companies.

    Love, Mikie
  4. kar1953

    kar1953 New Member

    My doc did send a 16 page report to my ins. co. & they still denied it. I have the right to request a copy of any documentation that they used to make their decision & will do so. I just wonder if they will send me everything. I'm sure they will send my docs report - I could easily find out if they didn't - but whatever documents they used other than his report - how will I know if they send me everything? I won't.

    I showed the letter to my doc today & he said that the phrase "treatment of choice" is probably the wording in my policy so they can deny the unit.

    I just heard of another unit called the MENS unit - have to do a search. I had inquired from the Medcare Service website if they would recommend the TENS unit for fms & the guy who emailed me said the MENS unit would be better. So I'll check it out & maybe if it sounds like it will do a better job, maybe we'll try that.

    I also will be starting another round of PT - 12 visits starting tomorrow morning. Can't wait for that. When doc examined me today he said he could understand how much pain I'm in. My muscles are hard as rocks from neck to lower back.

    Anyway, thanks for your input. I appreciate it.

    Take care.....Kathi

  5. Mikie

    Mikie Moderator

    Exhaust all grievence steps and as a final attempt send a letter telling them you are filing a complaint with the state insurance commissioner's office. When all else fails, this sometimes does the trick. Ins. co.'s live and die by their record with the state.

    Love, Mikie