Find out why your health insurer denied your claim. from ProPublica

[justaprogressive]

ProPublica’s Claim File Helper lets you customize a letter requesting the notes and documents your insurer used when deciding to deny you coverage. Get your claim file before submitting an appeal.This free tool is part of our “Uncovered” series on health insurance denials. Please note that ProPublica is unable to provide any legal advice about claim files. We are journalists and not lawyers.

https://projects.propublica.org/claimfile/

[Jilly_in_VA]

1. I tried to get some much needed surgery on my ankle

Background---I trashed my ankle when I was 17, getting out of a car, of all things! Nowadays I'd have been taken to an ER, gotten an MRI, the whole bit, but back then it was next day, see the doc and have it treated as a simple sprain, Ace wrap, etc. It was years later, in my late 30s or early 40s, that I found out I'd torn all the ligaments in that ankle. Well, well,. No wonder it "goes out" on me at inopportune moments! The orthopedist recommended surgery and a possible Gore-Tex ligament. Pre-authorization claim denied. Why? "Pre-existing condition" because I'd been waling around on it all those years. Medicare would probably do it now, but the risks of anesthesia and the whole bit with therapy would be a pain in the butt.

[Historic NY]

3. Same thing happened to me...

Orthopedic Dr years later x-rayed my ankle which was injured and asked when did you break it. That very bad sprain was a broken ankle.

[Silent Type]

2. Best thing is let providers file any appeal. They have staff with expertise and your medical records including tests

and medical history.

They have an incentive to get it done if they want to get paid, especially on expensive services.