Advice on filing insurance appeal- I had a titanium plate and screws put into my wrist after a distal radius fracture which were deemed not medically necessary, hence my insurance will not cover the $4,000 charge. I have UMR top tier insurance in NYS.

I suffered a distal radius fracture a few months ago and the break was relatively neutral, leaving me two options for treatment. The first was a cast, but there was a chance that the bones could have continued to shift causing the bones to heal poorly and surgery to be required at a later date, or just get the surgery then which is what my orthopedist recommended. Insurance covered the cost of the surgery in full, but will not cover the cost of the titanium plate and screws, claiming that they were “not medically necessary”. I already had my insurance review the claim and they denied it a second time. My next step is to file an appeal. Does anyone have any advice on fighting this claim? I am happy to provide more details if needed.

submitted by /u/tqbu_cypher
[link] [comments]
I suffered a distal radius fracture a few months ago and the break was relatively neutral, leaving me two options for treatment. The first was a cast, but there was a chance that the bones could have continued to shift causing the bones to heal poorly and surgery to be required at a later date, or just get the surgery then which is what my orthopedist recommended. Insurance covered the cost of the surgery in full, but will not cover the cost of the titanium plate and screws, claiming that they were “not medically necessary”. I already had my insurance review the claim and they denied it a second time. My next step is to file an appeal. Does anyone have any advice on fighting this claim? I am happy to provide more details if needed.
submitted by /u/tqbu_cypher [link] [comments]Read Morer/HealthInsurance

Leave a Reply

Your email address will not be published.