IDET* is paid for by some Medicare and healthcare insurance plans, provided the service meets all coverage and payment requirements outlined in each plan. However, if your claim for the IDET procedure treatment is denied, you may consider challenging this decision by preparing an appeal.
An appeal is a request to have a higher authority review the denial of your claim. If you decide to move forward with an appeal, it’s important to carefully review guidelines for the appeal process that are outlined in your insurance denial letter or insurance policy. The following tips may help you get started:
- Review your denial letter to ensure that your healthcare plan is in compliance with the law.
- Review your denial letter to find out the basis and clinical reasoning behind your insurer’s decision.
- Review your policy as it relates to the denial.
- Attend appeal hearings whenever possible.
- When attending appeal hearings, present your case tactfully and avoid a confrontational tone that criticizes your current healthcare plan. Explain your case in 2-5 minutes.
Each appeal is unique and each piece of evidence you provide in your support (your “appeal package”) should include necessary information to make your case. The following items are generally present in most appeals:
- An appeal cover letter.
- A letter of medical necessity from your treating physician
- Some physicians are reluctant to provide letters of medical necessity, but this could be the difference between a favorable and unfavorable appeal decision. In most cases, your treating physician is the most qualified to write your letter of medical necessity.
- Portions of the insurance policy related to the appeal, if applicable.
- Any other supporting documentation, including clinical or diagnostic studies, peer-reviewed articles that support the procedure’s effectiveness, and/or general overviews of the procedure.
For further information about the appeals process, please visit the following resources: