Appeal tips and tricks - data?

[kcollette]

So my insurance company (HMO) has denied my middle fossa surgery at UCSD (Friedman and Schwartz) even after a peer-to-peer call with them. They say I can just get the surgery in-state, which, technically, I can but I'd really rather go to UCSD to doctors who specialize in acoustic neuroma surgeries and do them all the time.

If you've had success having your HMO cover an AN surgery out-of-state, can you share what type of information you sent? I think I read a post here where someone got a consult in-state and got data on the numbers of surgeries and successes for the in-state surgeons and provided that and the (better) stats from the out-of-state surgeons and had success that way but if I don't have to do that, that would be easier, obviously.

My surgery is scheduled for the end of November and I was just about to buy plane tickets and book hotel rooms but, ugh, now I have to wait, possibly indefinitely.

[Traveler]

I would love to hear about any methods to compel insurance company to approve my MRI that was originally requested by my ENT!!!  It is extremely frustrating with Anthem here in Maine.  Yikes.  Meanwhile my symptoms continue to grow more challenging with each passing day.

[kcollette]

I’m so sorry to hear that! I wasn’t able to convince my HMO to cover the surgery out-of-state s because there are surgeons in the state who do the same procedure. I ended up switching to a PPO for next year so I can get the surgery where I want to. Good luck getting your MRI covered!

[CA Marti]

Honestly, I would switch insurance to blue cross blue shield ppo silver plan if you still can. I found it to cover the most for surgeries. It is expensive but it is worth it for our situation where we need multiple mri's and expensive surgery.
Best wishes,
CA Marti

[kcollette]

Thanks! I’m not sure if that’s the plan my company offers or not but other employees have told me it’s really, really good. I hope they’re right! The HMO was amazing except for this one issue.