Denied!!!!!!!

I was denied by Blue Cross HMO today. They stated that my paperwork did not show medical necessity. Can someone tell me where to go to get some examples of appeal letters. I am devastated. I have joint problems(knees and shoulder) and hypertension. Any suggestions would be greatly appreciated as I am now a total wreck. I had hoped to have surgery before the end of the year, now I just hope to have the surgery.

Sorry about the denial. You might try looking at the Insurance Help Forum messageboard or perhaps in the library on ObesityHelp.com. Got to the main page and click on the forums in the upper left corner, you should find the Insurance forum along with others. Hope this helps. James

I was denied by cigna HMO and I hired Roberta to help me with my appeal...she has a 100% success rate....you can reach her at [email protected] She is a Georgia girl too Email me if you have any ??? Good luck! Sherry

I am so sorry Melanie. It is so frustrating to deal with insurance, I myself have BCBS and am about ready to submit my paperwork. What is happening to you is my worst fear. I would definitely appeal, I think insurance mentality is if they deny you, you will just give up and go away. DONT DO IT!!! Fight for what is right, fight for yourself, fight for what you need to begin a new and healthy life. I saw an example of an appeal letter somewhere on this site, if I can find it, I will email it to you. Stay as positive as you can, it may not be easy, but it will be worth it! Good Luck!!!

Sorry Melanie that you are going through this. I know all to well how you feel. I was denied also and I'm trying to complete a 6 months physician supervised diet. You should post to the main board also. You will get a lot of help with sample letters. Good luck with your appeal. Shon

Melanie, I'm not sure about appeals letters, but don't give up! Sometimes they deny you just so you will give up. I'm feeling pretty good you will get approval with this 2nd letter. Amy

Hi Melanie, Oh Melanie, I'm sorry to hear that yucky news!!! I was denied on 9/23 by BlueCross BlueShield HMO of Georgia...they said the same thing for me...they would not tell me specifically why, they said that my surgeon would have to call. Finally, I found out that they denied me because my BMI is only 39.7... Duh, we knew that going in, however, I have a long list of comorbid conditions and according to their policy I do fit the criteria... I ended up changing surgeons because my Dr.'s office does not "do" appeals they leave it up to your or your PCP to do. However, the insurance company wants to hear from the surgeon (the person who submitted the paperwork)...the surgeon's staff was just like oh, well, too bad.... I was really mad that they don't fight for their patients. I have been told to almost count on getting denied the first time but I just need to keep appealing...so, if they had of told me that they offer no help if/when it happens I would have never chosen him as my surgeon. Not alot of good an excellent surgeon can do without getting approval to do the surgery! The new surgeon's office does fight/appeal on the patients behalf and pulls out all the stops when it comes to getting their patients approved! My old surgeon's office did not even want to get on the phone with the insurance company to find out why I was denied!!!! I think that Wings around atlanta has a appeal letter that might give you some ideas. You will want to find out the exact reason why they don't feel that it's medically necessary (mine was because my BMI was below 40) and you'll want to address that in the letter. You'll also want to explain to them how morbid obesity is affecting you...how it and your comorbid conditions affect your life and way of life and why it would be a benefit to have surgery. Anyway, I wish you the best of luck...keep on the path and don't give up! You know what they say, good things come to those who wait!

Melanie I am so sorry you were denied. I would think a BMI over 40 would be approved with no co-morbidities. I have a friend that was denied 1st time but later got approved and I believe you will too. Hang in there and good luck. Debbie