Help writing an appeal for DME

Hi all,

I am looking for help writing a letter to appeal the amount of funding my private health insurance is willing to provide for a new wheelchair. To summarize, my insurance is only giving me about 25-30% of the cost of the quoted wheelchair and parts cost.

For reference, this is my second chair through insurance (7 years since first chair), the first was obtained through a national DME vendor, and my coinsurance is 20%. This time I am going through a vendor that does not do insurance submittals on my behalf, they are just helping to measure me and fill the order form, all costs are direct MSRP from manufacturers as well, so cheaper than going through the national DME vendor. They gave me an official quote. I self submitted the claim to my insurance with the quote. Along with it, I submitted a detailed letter from my rehabilitation doctor outlining my continuing necessity, diagnosis and codes, the special cushion, backrest, and push rims needed for my needs, etc. I checked with my insurance before submitting to make sure I had all the right information and details for the claim and was told so.

Insurance isn't even covering 50% of the tires i choose (nothing special, the basic everyday tires most wheelchair users use) and denied the backrest (the same one i have on my current chair) and everything else, only about 25-40% is being covered. I am being told to write an appeal for more funds but I have never done so before and am having trouble coming up with arguments to my benefit.

I would appreciate any advice to help me draft the letter of appeal!

submitted by /u/Honeybee0711
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