Overturning Denial for Montecatini Eating Disorder Treatment Center

A family from Washington State faced an uphill battle after their insurance claim for their loved one’s care at Montecatini Eating Disorder Treatment Center in Carlsbad, California, was denied by Regence BlueShield. The insurance company deemed the patient’s 67 days of Residential Treatment Care (RTC) from 12/28/2022 to 03/06/2023 as medically unnecessary. Left with nowhere to turn, the family sought the guidance and support of FixMyClaim.

At FixMyClaim, we pride ourselves on offering swift, professional claim and appeal assistance. Our expert team diligently collaborated with the family to gather the necessary evidence. Armed with this information, we launched a Level One appeal that outlined a compelling argument with supporting medical records to emphasize the critical need for the patient’s treatment.

Despite our best efforts, the internal appeal was not successful. Undeterred, we escalated the matter by requesting an external review from an independent entity, IPRO. Throughout the often-complex appeal process, our team continually updated the family, offering clarity, reassurance, and easy-to-understand explanations of each step.

Ultimately, persistence and expertise triumphed, as IPRO overturned Regence BlueShield’s initial denial. Recognizing the medical necessity of the treatment, the external review organization authorized the full payment of the claim.

Here at FixMyClaim, our mission is to simplify the complexities of insurance claims and shoulder the burden for families in their time of need. Our expert team skillfully navigates communication with insurance companies, providing the guidance and experience to support you through the process.

When faced with challenging insurance claims, trust our experts at FixMyClaim to help you overcome the obstacles and ensure the best possible outcome for you and your loved ones.

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