What are the reasons why a health plan will deny MRgFUS treatment?
A health plan will base their denial on a combination of three different rulings. The plan may rule that MRgFUS is a “non-covered service” for its eligible members; it is “not medically-necessary” for the treatment of uterine fibroids or for a patient specific case; or even though it is an approved by FDA for this condition, from an insurance company perspective they consider this an “experimental or investigational” treatment. Your right to an external independent review will be dependent on the reason cited for the denial and your health plan’s eligibility criteria for an independent review of a denial made through the grievance process. Do I need to write a letter of appeal and forward it to my health plan? For both the grievance and the independent review process, you are typically required to formally appeal their denial decision in writing. Prior to writing your appeals letter, go to the Web page for your health plan, or contact them directly for specific instructions on what wri
