r/HealthInsurance • u/Kamikazepyro9 • Apr 09 '25

Medicare/Medicaid Insurance denied my wife's medically necessary hysterectomy. How do I appeal? Tips for this fight? (Colorado Medicaid by United Healthcare if it makes a difference)

As title states, we have had my wife's hysterectomy scheduled since December. We were notified today that insurance denied the authorization. Her OBGYN and our Primary Doc have both said it's medically necessary.

What steps do we need to take to fight this decision? They want her to "try other methods" but we've already gone down that route and jumped those hoops. This has been a multi-year fight to get to this point for it to be denied...

Edit: Got the denial letter in today - reason for denial is due to them only looking at our history with our current OBGYN (1ish year)

They did not look at her history or any medical records from other OB offices and our primary doctor office.

Even though they have access to this data, I'm compiling it all into a single documented point to send alongside the appeal letter. Her OBGYN has also said she'd be requesting a peer to peer review as well.

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