M
marcicorey
Guest
My name is Marci and I am from Oklahoma. My HMO has denied a specific type of therapy for my infant daughter because they state it is purely cosmetic and the policy excludes cosmetic treatment. I have two letters of medical necessity from my pediatric neurosurgeon and one from my pediatrican saying the treatment is necessary to avoid major neurosurgery. The HMO appears to be ignoring these letters. After three denial letters (spanning about three months) stating that the treatment is cosmetic they sent me a denial to my Level Two Appeals stating that the treatment is cosmetic and this time they added that it is not FDA approved. It is true that the treatment is not FDA approved, but a statement was made to me over the phone by one of their people that even though it is not FDA approved, it can be considered on a case by case basis. We have proceeded with the treatment because time is limited since our daughter is so young. We have paid for the entire thing out of pocket and want very badly to reimbursed. Can I file a suit against them? I have completed their appeals process already.
Thank you,
Marci Corey
[email protected]
Oklahoma
Thank you,
Marci Corey
[email protected]
Oklahoma