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Best Way to Appeal HMO decision?

18 years ago

I had been in a lot of pain for months. I was taking about 20 Tylenols per day for the migraine headaches and oral pain. Within the last two months, I visited the dentist twice about the pain. She took X-rays and stated the pain was due to night time teeth grinding. Last week, everything came to a head. Half my face became extremely swollen (one of my eyes was practically closed shut) and the pain in my mouth, throat, ear and eye was just about unbearable. My GP diagnosed sinusitis and referred me to a Ear-nose-throat specialist. The ENT doctor correctly diagnosed a tooth abscess and referred me to an oral surgeon. However, my HMO rejected the referral, claiming they would not cover dental treatment for cosmetic purposes. Independently, I found a new dentist who provided treatment.

Had I not received dental treatment, the infection could have spread to major organs. I had rheumatic fever as a child. How do you suggest I appeal the HMO's decision besides including the dentist's treatment record (seared the abscess and prescribed antibiotics) with my letter indicating the seriousness of the infection.

Thanks for your suggestions.

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