Insurance Denied

Please HELP!!! I know this has been asked before but now I need help. My insurance denied me because "not medically necessary". I am 5'11" and 295 lbs, high blood pressure, mitral valve leakage, DJD in my spine. Does anybody have appeal letters as a guide for my appeal? Any and all help would be appreciated. My primary has written a strong letter, I have a psychological I am picking up Monday to also send along with Drs notes from prescription WLS meds in 96 and 99. Unfortunatly, I do not have the proof of Phen Fen because I went to a clinic that is long gone since it was pulled from the market and they filled the script at the clinic weekly so I cannot go to a pharmacy for the receipts. I am just so tired of being sick and tired from being overwight. Also, I had verticle gastric banding 15 years ago and my meal consumption is still pretty limited so that is why RNY is recommended for the malabsorbtion aspect. All my tests upper GI, bloodwork, gallbladder ultrasound, stress test (which I failed and had to have a cardiac cath done), H pylori have been all done and the insurance paid for all of this. PLEASE HELP!!!

Why did they say not medically necessary? You have a BMI of 41.1, which puts you in the Extremely Obese category. Is it because of your prior surgery? I would say appeal and if necessary, hire an attorney. Good luck. Red

There are definitely WLS attorneys you can contact. Have you called the insurance company to ask them what they are looking for?? Don't give up!! Jan