
<b>Petitioning for Medical Coverage of Disputed Treatments</b>
What happens when your medical coverage denies payment for treatment or consultation, or denies you access to treatment or consultation?

First, arrange to have a case manager or other person deal with you directly.  Get a contact that is knowledgeable and competent.  Make a note of their name and extension and department.

Second, get a referral or recommendation from your doctor for the consultation or treatment.

Thirdly, attach to your appeal -- justification for your having this consultation or treatment.  This should be reputable information from medical journals, not ads from internet sites.   

Fourthly, if they are refusing something that they cannot provide in their organization or network, ask them who they have who CUSTOMARILY treats your rare cancer, or CUSTOMARILY does the procedure.

See the Center for Health Care Rights
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<b>EXAMPLE</b>
Your insurance company or HMO or Army hospital refuses your request for a consultation with a sarcoma oncologist.

Contact the institution and either arrange a case manager for your case, or ask who the person is who you should talk to about petitioning for your sarcoma oncologist consultation.

Have your GP or internal medicine specialist or oncologist or surgeon write a letter stating that you should be seen by a sarcoma oncologist to discuss your treatment options and have multiple questions answered.

Attach PubMed abstract printouts.  If you go to "&&url" you will be able to link to the Pubmed abstracts and print them out.  These 6 references each indicate that patients with sarcomas have better survival statistics if they are treated at a sarcoma center.

If the institution is resisting sending you to a specialist, DEMAND that they provide you a list of physician/oncologists who "customarily treat" LMS rare cancer. VERY IMPORTANT.

Usually the accumulation of recommendations and evidence will do it.  You can also name state and federal boards of administration, and tell them that you WILL contact the state/federal government sites.  

More detailed instructions can be found below.

doctordee
August 2005
