My insurace is denying my request for Psycosocialrehab services

[DisabledGeek89]

What is the name of your state? Virginia

First off if this is the wrong sub forum, please move this thread.

I was told by a worker at my mental health treatment program that my insurance is not renewing my payment due to the fact I have been attending the program for years and I am looking for advice how to help my case when I word my appeal. I have autism and I am recovering from mental health trauma. Should I play up the latter? Use it to gain some sympathy from the clerk? I went through mental hell for much of the new 10s. I could say I am a crisis away from a relapse with depression. Any input is welcome. I emailed my case manager. She is out of the office today.

 

[Zigner]

Your first step will be to get a copy of the actual denial (in writing). You should be able to download this from the insurance company's website.
Do you have private insurance?

 

[DisabledGeek89]

Your first step will be to get a copy of the actual denial (in writing). You should be able to download this from the insurance company's website.
Do you have private insurance?

Disabled Adult Child Insurance from Medicare/Medicaid and not yet, a worker at the program told me today.


EDIT-I have a reference number and I am currently on hold.

 

[christian_342]

Don’t “play it up” emotionally. Stick to facts, diagnoses, and how the service is medically necessary for you to function.

 

[cbg]

I started a long response but before I do, I need a little more clarity on exactly what your insurance is and the status of the claim.

Are you saying that you have DAC benefits? Through the Feds or through the State? Or both? Do you have any additional insurance either through your own employment, a spouse's employment or possibly a parent's employment? If so, what is it, and which is primary?

Do you have written confirmation of the denial? If so, please look at it very carefully. Does it say, We are not going to pay this claim, or does it say, we are not going to pay this claim until we receive x information? (I cannot tell you how many times, when I was working for a national insurance carrier, our claims office would send out something like, We cannot pay this claim until we receive x or y document or information from your doctor, and the recipient stopped reading after the word, claim.)

If you can answer these questions, even if it takes a few days to get the information, I can try to help.

 

[DisabledGeek89]

I started a long response but before I do, I need a little more clarity on exactly what your insurance is and the status of the claim.

Are you saying that you have DAC benefits? Through the Feds or through the State? Or both? Do you have any additional insurance either through your own employment, a spouse's employment or possibly a parent's employment? If so, what is it, and which is primary?

Do you have written confirmation of the denial? If so, please look at it very carefully. Does it say, We are not going to pay this claim, or does it say, we are not going to pay this claim until we receive x information? (I cannot tell you how many times, when I was working for a national insurance carrier, our claims office would send out something like, We cannot pay this claim until we receive x or y document or information from your doctor, and the recipient stopped reading after the word, claim.)

If you can answer these questions, even if it takes a few days to get the information, I can try to help.

I have not got the letter yet but I will sum it up once I do.