i need help with an appeal letter !!!!!!
Chris- You might want to go to the main message board to get more replies. At www.gastricbypassfamily.com there is a great deal of information there as well. Good luck with your efforts.
Cheri
Chris,
If you go to my profile and scroll down to 7/23/03, I have put a copy of my appeal letter on there. It is a little hard to read, the format is just one big paragraph whereas I made it into several smaller paragraphs for readability when I sent it in. I lost two appeals and went to an outside arbitrator and won finally. DON'T GIVE UP! Base your appeal letter on financial facts (you know, stuff like "you insurance guys will pay so much more for me if I don't get the surgery") and quote research. The arbitrator made me do six months of "traditional" weight loss before they decreed that I could have surgery, but the insurance company had to pay for the weight loss clinic as well, and it prepared me for the surgery. So it all worked out the way God wanted it. Just keep plugging away. "The squeaky wheel gets the oil" and all that. Remember, if it actually gets down to the bottom line, there are lawyers that specialize in helping people win weight loss surgery from the insurance companies. Save that for the last resort.
Karen Craig
LAP RNY
350/255 so far
Chris,
My only suggestion is to write it from the heart. I got denied 2x and then finally wrote an appeal letter and wrote it from the heart. I talked about my family and my son and how much he needs me and I need him. I talked about all the diets I tried and all the failures I had. I truely don't think that having a "scripted" letter is the way to go. I got my approval 1 week after sending in my heartfelt letter. I just told them how it was. I gave the insurance more of a personable letter than a stuffy "doctor" letter. I guess it worked. I am a little over 6 months out and just hit the 100 pound mark! Good luck to you and don't forget that we are all here for you. Just write from the heart!
Jen
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