Appealing

Anyone else been through the appealing process? What did you do? How did it work? I'm going to have to appeal, but I don't even know where to start. I need to get a letter from my pcp, I know, but beyond that I'm completely lost. And my insurance booklet doesn't realyl say anything about how to go about doing it. Anyone willing to coach me, or even just offer a little advice? Please???

Dear Jacqueline: I was denied from my insurance company two weeks ago. I first got the denial over the phone, and then received a letter. Did they give you a reason for the denial? My company said that I needed to be on a medically supervised diet for six months. I talked to the insurance rep in charge of precertifications. She claimed I could not appeal a precert. decision. I talked to her supervisor, and she was more helpful. She basically told me to submit any more additional information, and they would consider it. I haven't gone through any official process. I did get a letter from my pcp, the bariatric surgery coordinator, and I wrote a letter also. These three letters were faxed in, last week. I'm to call back in two weeks. I went back to my Dr. also, to get started on a "medically supervised" diet. If my appeal letters don't help, I will do it their way, do the six months, and resubmit. I'm even considering hiring a lawyer, if need be. There are some good examples of appeal letters, on this site, under the insurance heading. There's also a site called obesity law.com, that specializes in helping with appeals. Best of luck to you, let everyone know what comes of your appeal! Hope this was some help!! DeeAnn R.

First I was denial now I'm "re-review" who the hell knows what is going on pardon my french! Anyway, since I'm diabetic, hp, high cholestrol, fibromyalgia I decided to call the pharmacy & ask for a print out of all my meds NOT paid by title 19, but what exact costs are. I told him what it was for & he was more than happy to oblige! I'm going to submit that along with 2 doctors, (PA & doc) reports. In my letter (rough draft) I have listed my goals, like riding a bike again, walking etc, my family history etc. I'm hoping that this will gain some points. ALSO I wrote to Vilsack & Grassley. I got an email back from Vilsack's office, they submitted my email to the Director of DHS & this gal had also talked to them trying to get this overturned, the denial or whatever you want to call it. I suggest you write Vilsack's office & anyone else that has been denied do the same. In that email I asked who these people were to play God with my life that if doc & surgeon felt this surgery is medically needed then NO ONE should play God with us. Think I got their attention I also have a paralegal friend that has had WLS & would be more than happy to advocate. Let me know if you want his email addy & will be happy to pass that on. Carolyn

I am on my 2nd appeal. This time I have gotten copies of ALL my medical records pertaining to my back pain (ER visits, clinic visits and pain specialist visits). I also went to my pharmacist and had him make a print out of all the meds I have been on for the past 3 years for my back. My PCP is documenting my weight loss attempts for the last 2 years. If all of this doesn't help, I am going to report the insurance company as a bad faith company, as they are not treating all insured the same. Basically, give them as much paperwork as you can that states you have a medical condition that would be improved by wls. And the supervised weight loss documentation is a must. Call your insurance company to find out if they require 2 years or 6 months. Hope this helps! Good luck!!!! Sheila