Denied.....any suggestions for my letter?

I was denied by blue cross ppo MRMIP. The therapist said I was not aware of the outcome and somewhere it states that I didn't diet for 2-3 years ****rue). I am giving it more time and going back over my steps with the therapist and dietition. Any one have any suggestions for my appeal letter?

Hi Karla, Proof is the magic "word". Can you show proof of your weight loss efforts for those 2-3 years? Doctors notes often reflect the fluctuation in weight and can prove you have worked at weight loss during those times. Chart notes can be worth their "weight in gold". Funny thing though, I tried to help myself some years back and as a result my BMI dropped so low that my insurance company tried to use that against me saying my BMI wasn't low enough for long enough. Go figure. Persistance is the key. I was denied and then decision was overturned. Reasons for me were very different however, but in the overall picture, those chart notes need to be loked through with a fine tooth comb. Don't forget ALL doctors you have seen through those years. I gathered up chart notes from all 3 of my doctors. Keep the faith and don't give up. Darla

THank you for responding. Im so grateful for this site to have the support. I have an appointment tomorrow with my PCP. I have made notes to get as much info from my charts as possible. I met with the psych today and she gave me a complete support letter but it was the test results that got me in the hot seat. Hopefully my new letter from her will change their minds. Thanks again for the support. karla

Hi again Karla, Now that's the spirit...you go get em girl!! P.S. I know exactly what you mean about the support found in this site....it helps us all without a doubt. Best wishes that we will be seeing you on the Loser's bench in the near future. NEVER GIVE UP. Darla

I am so sorry that you have had to go through this. Like Darla said though proof is the magic word. Someone overlooked something. My suggestion is to get a copy of all records for that time frame from any doctors that you were seeing. That includes any records from weigh****chers whatever it takes. Whatever type of diet you were on at the time and who monitored it. Don't depend on anyone else to make sure the insurance company gets what they need. Call them and find out exactly what the criteria is. Hope this helps!! Big (((((hugs))))) coming your way!!! Anna

Thank you for your support. I am thankful for all the wisdom comming from members. karla

I am sorry you were denied. I think most of us have been at least once, maybe twice. Check out the insurance forum here at OH. When I was denied, I got great help there. I copied a form from the insurance forum site for my doctor to fill out in place of the letter stating I had been under 6 months of supervised diet. He copied from my medical records to the form and put it in a monthly format instead of a summation format. I called my insurance and worked to get to THE person, who explained what was missing to receive approval. It was not at all what my letter from them said! Bear in mind that my insurance has no written booklet telling me exactly what is covered and why. At her suggestion, I added several doctor recommendations and updates on my health whi*****luded co-morbidities. By contacting and developing a good rapport with THE person, she put a rush on my paperwork and once I had everything submitted, she had an answer for me within 48 hours. The best advice I got on my insurance was from my chiropractor. He told me that I needed to remember that it was not my doctor's responsibility to get me approved. It was mine and to not hesitate to call and talk directly to the insurance. Be friendly then be emotional if necessary but be consistent in checking with them and work to get what you need. You will prevail! Take care and God Bless! I will be checking on you after my surgery tomorrow as soon as I get back to a computer. Katy B