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EXCLUSION....Not Decision...Still a chance?
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I agree with Minnie. If GH is covered for children with GH defiency then it is likely to be covered in the case of documented GH defiency in an adult. The trick is to be persistent. Low level denials are usually generated by clerks who have little medical background. They function by following a rigid formulary - ie there are no brains behind their decision. You need to get bumped up above this level. To get bumped up you amy need to do any or all of the follwoing. Have your endocrinologist file a form (specific to your insurance and compnay) veryifying medical necessity. It helps if you are being seen at a well known clinic though any physician can do this. The important thing is that you have a medical necessitiy. Make this a mantra - MEDICAL NECESSITY! MEDICAL NECESSITY! MEDICAL NECESSITY!MEDICAL NECESSITY! Remember that the insurance company probably thinks that you want this to delay aging (as one with acromegaly - this is an insane use of GH). 2) If you were unsuccessful contact the patient advocate at your health insurance company. For my company you contact the business office. They are required to have and advocate and must give you the number if requested. The advocates are very helpful and really tend to be on the patient's side. It might be useful to post the name of the company and maybe someone on the board has experieince in handling a similar situation. The main thing is you are ealy in the appeal process so don't give up yet. |
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