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Week Long E.E.G. Level Two Appeal Help

Sat, 01/27/2007 - 15:27
I'm about to send off a letter to my insurance for a level 2 appeal in order to get a week long e.e.g. approved (first appeal was denied) in hopes of finding out if I do have temporal lobe epilepsy or some kind of neurological problem. Doctors aren't sure either way but they have encouraged this test, and so far this is what I have to send: a letter from my neurologist saying that i've had a history of spells and he can't exclude seizures a letter from neuropsychologist saying that TLE isn't very likely but at the same time they can't exclude the possibility of seizures acting on the frontotemporal lobes more indepth letter explaining the neuropsych's findings and various symptoms i myself have experienced and written down im also thinking about sending my insurance article from various sites detailing the symptoms of TLE, but I'm still not sure if this all would be enough since at the moment nobody knows either way and a lot of times insurance look for hard evidence first before they approve a procedure like this. so if anyone does know what else i should say in my letter or what else i could send them, i'd appreciate it. thanks

Comments

Re: Week Long E.E.G. Level Two Appeal Help

Submitted by Anonymous on Fri, 2007-02-02 - 08:15
Thanks for writing in - just wanted to add a tip. Most often, insurance companies want to know why a specific test or hospitalization is medically necessary to answer a given question. Thus, information on why EEG telemetry is needed to determine if a person is having seizures, and then to determine a course of treatment is helpful info for appeals. Supporting documentation about the role of EEG testing can be used... see the National Association of Epilepsy Center for guidelines for comprehensive epilepsy centers.

www.naecepilepsy.org/guidelines/guidelines.html

Hope this helps,

Epi_help

www.naecepilepsy.org/guidelines/guidelines.html

Hope this helps,

Epi_help

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