For the last 6 months, I have had an orthodontist, radiologist, and 2 surgeons conclude that I need upper and lower jaw surgery to correct my non-functional bite. This surgery needed to be pre-approved by my healthcare company.
I have a PPO with a major healthcare company who has denied the claim and just recently denied after having a peer to peer with the surgeon.
My next step is to appeal the case directly with the insurance company. I need help drafting this letter. I will include all doctor recommendations for surgery, clinical notes, and healthcare denial letters.
I am preferably looking for someone who has worked for a major healthcare company in the medical claims processing department who understands what it takes to win an appeal.