Hello everyone I was hoping to get some insight or advice on what to do (was told to post this here please direct me or pm me a link to a similar scenario as mine if this is the wrong place, I’m not familiar with reddit).
I’m a 25yM and I’m covered under my dad’s insurance through his work (NALC Cigna PPO). Coverage will end October 2021. Last February I was diagnosed with keratoconus in both eyes which causes the cornea of my eye to lose thickness and bulge out causing issues with my vision. It’s a progressive disease and in order to help stop the progression I need to get a procedure done called corneal cross linking. Without the procedure I will almost guaranteed need a cornea transplant later down the line. This procedure can prevent that likelihood.
My insurance originally denied the procedure in March, (I didn’t follow up because my vision was fine then and I thought it wouldn’t get worse..stupid I know) Then I went back to my doctor in October because I definitely am experiencing worse vision and they denied it again last week again. Their main reasoning is that my vision is still 20/20 while corrected with glasses. I checked a couple other insurance companies like blue cross and I’d fit their criteria to get the procedure done (cornea is losing thickness rapidly from February to October visit, I’d be approved under their specified number). I’m still waiting for NALC to send me their codes so I can see what their criteria is in detail. They also don’t do peer to peer reviews so I have to file a claim myself.
I was hoping to get advice on how to file an appeal for reconsideration and review to get the best odds possible. Specifically what I should write to supplement documentation? I know nothing about insurance in general so this task seems daunting and I want to make sure I have the best chance as the procedures in total will cost $7,000 per eye. Thank you for any and all advice/help.
submitted by /u/keratconus2x
[link] [comments]
Hello everyone I was hoping to get some insight or advice on what to do (was told to post this here please direct me or pm me a link to a similar scenario as mine if this is the wrong place, I’m not familiar with reddit). I’m a 25yM and I’m covered under my dad’s insurance through his work (NALC Cigna PPO). Coverage will end October 2021. Last February I was diagnosed with keratoconus in both eyes which causes the cornea of my eye to lose thickness and bulge out causing issues with my vision. It’s a progressive disease and in order to help stop the progression I need to get a procedure done called corneal cross linking. Without the procedure I will almost guaranteed need a cornea transplant later down the line. This procedure can prevent that likelihood. My insurance originally denied the procedure in March, (I didn’t follow up because my vision was fine then and I thought it wouldn’t get worse..stupid I know) Then I went back to my doctor in October because I definitely am experiencing worse vision and they denied it again last week again. Their main reasoning is that my vision is still 20/20 while corrected with glasses. I checked a couple other insurance companies like blue cross and I’d fit their criteria to get the procedure done (cornea is losing thickness rapidly from February to October visit, I’d be approved under their specified number). I’m still waiting for NALC to send me their codes so I can see what their criteria is in detail. They also don’t do peer to peer reviews so I have to file a claim myself. I was hoping to get advice on how to file an appeal for reconsideration and review to get the best odds possible. Specifically what I should write to supplement documentation? I know nothing about insurance in general so this task seems daunting and I want to make sure I have the best chance as the procedures in total will cost $7,000 per eye. Thank you for any and all advice/help.
submitted by /u/keratconus2x [link] [comments]Read Morer/HealthInsurance