I Got Denied

By my insurance company on my second level appeal for the CPM and Gameready :-(
The billing people in my office had told me that if it got denied I could attempt a grievance appeal or something like that.

I thought is was a great letter. I will include it below since I have been asked for copies if it by readers.

To Whom It May Concern:
Please be advised that I have received a bill for a Game Ready TM Vasopneumatic Compression and Cold Therapy device, as well a Continuous Passive Motion Machine (CPM). These 2 pieces of equipment were prescribed to me by Dr. Bryan Kelly, the bill is from Biodynamic Technologies.

I went to see Dr. Kelly for disabling hip pain secondary to a torn labrum, which Dr. Kelly was able to repair via arthroscopy. Dr. Kelly prescribed the equipment mentioned above to maintain and increase range of motion (ROM) as well as to decrease inflammation and decrease pain, and prevent the build-up of scar tissue. At this point in time, there does not exist a CPM primarily for hips, therefore, a knee CPM must be used for all hip surgery. I would imagine that you do not deny charges for CPMs for patients that are status post knee surgery.

The Game Ready is unique because it supplies a combination of continuous cold therapy and intermittent pneumatic compression. RICE (Rest, Ice, Compression, and Elevation) is the universally accepted method of treating acute musculoskeletal injury and post-surgical trauma. The Game Ready device combines the two most difficult to manage aspects of the RICE regimen (ice and compression) in one easy to use system.

I am shocked to know that if an in-network physician prescribes a product to a patient, which in turn will help relieve their pain and reduce the possibility of further injury that you, a credible insurance company, would not pay for that product. I was under the impression that anything prescribed by my doctor would be covered. I believe that this decision was made unfairly, and would hope that you will rectify this matter immediately.

I have included a copy of bills from Biodynamic, Information on the Game Ready and a select list of clinical studies on cold and compression.

Respectfully,

Susie


I thought it was a great letter!!! I don't have the "select list of clinical studies" since I forgot to make a copy before mailing the letter. I obtained it by calling Gameready directly and explaining the situation to them. I will keep you posted on the progress!