Appealing an insurance decision

[Daria]

This summer my sixteen year old had a neuropsych evaluation done.  He hadn't had one in 9 years, and we needed one done to help advocate with the school, and for the college admissions process. The neuropsych had lots of super helpful information and strategies, it was excellent and really captured my complex kid, but none of the diagnoses in it were new.  However, the psychologist noted some lapses in attention that were not typical for a kid with ADHD and referred him to a neurologist to rule out seizures.  The neurologist found that he had sleep apnea, so now one of his diagnoses has changed from ADHD - PI to Attentional Issues caused by medical problems.  

 

My insurance company, which covers neuropsychs, has rejected the claim saying that it didn't lead to either "diagnosis" or "treatment".  My understanding is that it's because his diagnoses didn't change due to the testing, although they have changed since.  I'd like to appeal, and I'm thinking of appealing on the grounds that the testing lead to the neurologist, which was essential for diagnosis, and that having "pre-testing" was important if we're going to be able to monitor the impact of treatment for the sleep apnea.  

 

My question is, my insurance company allows us to simply resubmit to see if we get a different decision, and also to appeal by phone, as well as sending in more detailed info.  I'm not sure which is best?  I need to resubmit within the next few days, for complicated billing reasons, so I'd love to hear people's thoughts on how best to approach this.

[Ottakee]

Can you resubmit with more detailed information in writing and then still follow-up with the phone appeal if needed?

 

I just appealed a decision, it was denied so I appealed again and they paid the claim. I would keep going up the chain of command.

[kiana]

Does your neuropsych have an insurance person? A lot of times they can be very helpful with how to do things with a specific insurance company.

[Splash]

We appealed a decision and had to write a letter. Our doctor told us what to include in letter and actually so did one of the many people I talked to on the phone. Our appeal process took several months but eventually they paid.