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Neurosurgeon

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Submitted By kath16
Words 323
Pages 2
Katherine Magno

Allied Medical Center
1933 E. Frankford Rd #110
Carrolton, TX 12345

January 16, 2012
Attn: Director of Claims
BlueCross Shield Insurance
124 Halfway Road, #111
Phoenix, AZ 1236

Re: Katherine Magno
Policy #: 789-44-1010
Insured: Katherine Magno
Treatment Dates: December 14, 2011
Amount: $ 18,000.00

To Whom It May Concern

I am writing to assist our patient Katherine Magno in the appealing the decision of BlueCross Shield Insurance to deny his benefits for a Surgery on December 14, 2012. The basis for the rejection is that BlueCross Shield Insurance states they had no prior authorization on file for this date of service.
Here are some Treatments that we did:

• 191 Brain Tumor x4
• 61500 Craniotomy
• Frontal Lobe- $ 8,000.00
• Temporal Lobe- $ 5,000.00
•Occipital Lobe- $ 3,000.00
•Parietal Lobe- $ 2,000.00

I am appealing this denial as the denial of this claim is not warranted. The explanation of benefits did not provide enough information to establish the validity of this decision to deny the claim. Therefore, I request you to provide the following information to support the denial of the treatment.

Please provide the credentials and the name of the insurance representative who checked the treatment records. Also, please furnish the outline of the specific records reviewed and the description of any records that were missing and would be required to be produced in order to approve the treatment.

Please do review this claim again. The information provided is correct and the right diagnosis and the treatment is mentioned in the documents (a copy of which is attached with this letter as well). If you need any further documentation or medical reports, then please inform me within 7-15 days.

You can reach me at the following telephone numbers:

Office :( 907) 334-2134
Cell#: (907) 223-5768

Thank you for having read this appeal and hoping for prompt correspondence

Sincerely,

Lucy Stewart
Medical Office Specialist

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