Denial/Appeal question

February 2, 2004

My daughter (14) received her denial letter on the basis that the band is considered "investigative". I plan on appealing (to BC/BS also) but was wondering in the case that we win this appeal, is it possible to get another denial letter due to her age or does the Insurance company have to list ALL reasons for the denial in the first letter?

Any response would be greatly appreciated! :confused: Thank you!

Billie Branham

Alexandra · February 2, 2004

Hi Billie,

You can get a definitive answer to this question by calling your state insurance board--the rules may vary somewhat from state to state. But in general, insurance carriers must state all the reasons for a denial in the letter that is sent. Otherwise, they'd be able to string people along indefinitely denying things for one reason after another.

Once you receive a denial for a procedure you should be able to address the points in that one letter and get a resolution. Good luck!!

February 2, 2004

I really appreciate your reply, I had no idea where to go for the answer and you helped a great deal! I feel relief knowing that I have a chance at winning this appeal! I will also check with the state insurance board as you said.

Again, thank you for your time! :confused:

Billie Branham