I hope my post gives a path to navigate doctor offices and your HMO insurance to get coverage in other states where hip resurfacing is offered. As you may know HMO insurance contracts limit the territory to a local region of contracted doctors for your plan. In the case of … Continue reading →
Original PDF TRICARE Manual Here 4.10 Hip resurfacing (CPT2 procedure codes 27125 and 27130, and HCPCS S2118) with an FDA approved device is proven for the treatment of Degenerative Joint Disease (DJD) of the hip in patients who are less than 65 years old and who meet all of the following criteria: … Continue reading →
Appeal Letter to Insurance Company John Williamson January 17, 2006 Harvard Pilgrim Health Care 1600 Crown Colony Drive Quincy MA 02169-9777 Re: Appeal of denied coverage, HP0412161-00 Dear HPHC Representative: I am requesting for voluntary member reconsideration. Following is an explanation of my medical condition and history. In a letter dated December 23, 2005, HPHP…
Continue reading →November 9, 2007 HMO Help Center Department of Managed Health Care 980 9th Street Sacramento, CA 95814-2725 This cover letter accompanies my application for an Independent Medical Review (IMR). The core issue in this case is hip resurfacing (HR) versus total hip replacement (THR). In this letter I will discuss some of the main issues…
Continue reading →THE APPEAL LETTER TO CIGNA (NAU IS "national appeals unit") Dear CIGNA NAU: I have received your written notice, dated Aug. 27, 2004, denying my initial request for pre-authorization for left hip surface arthroplasty. With this letter and attachments, the request is being re-submitted for further consideration as an appeal of the initial denial. I…
Continue reading →To Whom it May Concern, Re: Appeal # xxxxx I want to bring to your attention an inconsistency in the TRICARE policies regarding total hip resurfacing and FDA-approved devices. Over the last 6-months I have been evaluated and clinically qualified as meeting all the criteria and indications for a Birmingham Hip Resurfacing procedure…
Continue reading →Dr. De Smet 2006 Insurance Appeals 101 For those of you who have not had experience with insurance appeals, here’s a couple of tips I learned helping patient families with insurance appeals: (1)First and foremost, read your policy – the full document with all of the legalese, not just the coverage pages. Your employer…
Continue reading →Obtaining Insurance Coverage for HR in Belgium RBHR De Smet Jan. 11, 2005 "I was able to return to my pre-surgery climbing level after six months, and was quite active in the second half of 2005 with climbing and hiking." Friday, January 13, 2006 Success with U.S. Insurance (LONG) Eleven months after surgery in Belgium,…
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