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RetroIsBack t1_ja6876y wrote

If you have insurance, The NH state insurance department is really good about forcing insurers to pay for "medically necessary" treatment as part of the appeals process. That applies to mental health treatment, but also applies to esoteric immune disorders with very expensive medications and some cancer treatments.

You must have good medical records, especially if the disease is chronic. Honestly, if you have good records that show other treatments have not worked, you don't even need to get a doctor involved.

  1. You are denied.
  2. Get the appeal forms from the state insurance company.
  3. Follow the instructions..attaching id, denial letter, proof of insurance, medical records
  4. Scan to Pdf
  5. Email/mail/fax to state
  6. It gets sent out to a 3rd party review. The treatment has to have been proven to be effective for treating the illness in general per FDA--not experimental--, it has to be a medical procedure, and other alternatives have not worked (your medical records)
  7. It comes back with approval or denial from 3rd party reviewer...a firm out of state with physicians and nurses who review your records....
  8. State issues order to insurer (very quickly)

If approved, the insurer has to pay. At this point the insurer is going to assign a single person to you to process everything because losing an appeal is a black mark on their record. Don't give them any info about the illness or progress, just ask them questions if necessary. If they create any more problems, such as limiting you to their pharmacy, tell them you are going back to the state.

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