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 your
benefits book. Print it, study it and quote the entire
definition in your appeal. Prove—point by point—that the
treatment IS medically necessary ... according to their own
definition.
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