I live in Illinois I am 35 years old. I have blue cross shield PPO I went to an approved in network health care provider/ infusion center .
I was sick during pregnancy with hyper emesis gravidarum. I had to have Infusions to stay hydrated five days a week 5 1/2 hours a day during my pregnancy to have a healthy child. I’m trying to figure out what to do for an appeal also because my insurance just told me they’re not going to cover anything they said it wasn’t medically necessary? Without these infusions I wouldn’t of been able to have my daughter. During hyperemesis gravidarum I wasn’t able to eat anything I constantly threw up and was extremely dehydrated. I’m trying to also figure out how to do an appeal?
Do I need a lawyer what do I need to put in the appeal letter I have never had to deal with this before? They’re trying to bill me for $100,000
I do not understand how if a doctor said it’s medically necessary in a letter they can still deny it ? Do I need a lawyer?
Here’s what I wrote in my appeal letter should I add anything?
To whom it may concern:
Greetings. this is my second appeal for IV infusions that were denied by my insurance from July 2021 Until October 2021. I was diagnosed with Hyperemesis Gravidarum By all the Physicians I have seen, including my primary care physician. They all prescribed me IV infusions for my health as well of the health of my unborn child.
I was unable to keep hydrated Not to mention unable to eat. In the many peer reviewed articles that I have read IV fluid infusions Are the main treatment for Hyperemesis Gravidarum, including the NIH and many OB/GYN publication’s. This treatment was recommended To keep me out of the emergency room setting due to the pregnancy, and the COVID-19 spread.
Without this treatment, My physical health was in danger as well as my unborn child. In my opinion, This treatment was medically necessary, And I do not understand why it is not being covered. I have been advise my medical records have been submitted with these claims. Please Re-review the medical records and reconsider payment of the claims. I also have attached letters from my doctor’s including the infusion center on why they believe this was a necessary treatment during my pregnancy for Hyperemesis Gravidarum. If there is anything else that is needed please contact me but , If this issue cannot be resolved We may have to obtain The services of an attorney.
Should I add anything take away anything?