Appeal letter
I don't have a letter to give you, just some advise...I am sure that the insurance compainies work somewhat similiar on either coasts. Find out what exactly (in writing) there criteria is in order to be approved for surgery. If you have those things such as the BMI requirements and the comorbidities, them they cannot deny. Just indicate in your letter what their criteria is (like they should knw right?? well, you would think...) and what your issues are. My insurance company first denied my son an insulin pump, which it clearly states that in order to meet criteria for an insulin pump you must be insulin dependent diabetic, taking multiple injections a day. So when I called to discuss and the "receptionist" told me that he didn't meet criteria....I asked her what the reason was and she said because he didn't take multiple inections a day and I asked "how many would be multiple...she said more that 1 and I told her that at that time he was taking 7. Anyway, he was then approved. My point is, you just have to educate yourself on the insurances and be smarter than them. Luckily for me, I am a nurse that works as a patient advocate to get them what they need while they are in hospital and the insurance that I have is one that I worked very close with at the time. But anyone can (and I highly recommend) educating yourself inorder to get what you need. Good luck and let me know if I can help!!
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