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Denied?

Experimental

"Experimental" does not mean what you think it means. It doesn't mean that the treatment is new, unproven or not FDA-approved. Experimental means whatever your insurer says it means. Find your insurer's definition of "experimental" in your benefits book. Print it, study it and quote the entire definition in your appeal. Prove—point by point—that the treatment is NOT experimental ... according to their own definition.

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Not medically necessary

"Not medically necessary" does not mean what you think it means. It doesn't mean that you don't need the treatment. It means that they don't want to pay for it. Find your insurer's definition of "medical necessity" in yourbenefits book. Print it, study it and quote the entiredefinition in your appeal. Prove—point by point—that thetreatment IS medically necessary ... according to their owndefinition.
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