Need help with Med. insurance

[Tstormwatcher]

About 2 months ago I filed a bunch of paper work to my health insurance co.
(Blue Cross Blue Shield Federal). The total charges were almost $2400. This was for numerous visits and a mouth splint. She had a severe case of Bruxism( teeth grinding). Now my insurance pays very little if anything for dental work which is what they consider this although her specialist doesn't because it can led to very bad consiquences to the jaw and surrounding muscles.
They ended up paying out just $600 and I wish to dispute this. How would I go about writing a letter to the insurance co. to help my case. I have never had to do this before so I am at a loss of how to word it. Thanks for any and all advise and help.

[gtalum]

I can't tell you exactly what to say, but I can give you some advice.

Explain concisely and accurately what happened and what result you want from them, without criticizing or threatening. You might also ask the doctor to write a supporting letter explaining exactly why he believes that this procedure should not fall under the dental category.

For faster response, you also may want to try calling the insurance company first. I have had denied claims overturned and accepted by making a simple phone call. They called it a coding error, but I personally think that insurance companies make a policy of denying a certain percentage of valid claims just to see what happens. If a phone call fails to change the status of your claim, then write the letter.

[Tstormwatcher]

Thanks gtalum, I'll try the phone call first.

[Pburgh]

gtalum, that is excellent advice.

If the doctor was a specialist, you should definitely get him/her involved.

[Tstormwatcher]

I called the ins. co. and they said to just write them a letter explaining my position and then I called her doc back and they said to just resubmit the original letter they gave my and in my letter just highlight what is said in that letter. If they decline me again then call back and the doc will get more involved.

[angelwing]

Also keep copies of whatever you send, I used to work for an insurance company and sometimes they may say they never got the paperwork. Also whomever you spoke to make sure you get their full names and their direct extension and the date and time you called and keep that information.

Whenever you get it together and mail it out, wait 5-10 buisness days and call them to see if they received it.