NEWBIE- In need of direction

Hello all, Has anyone had any luck with their first pre-detern letters. Both of my insurances, primary and secondary state that they do not cover weight loss and my primary has a bariatric exclusion. Any way to get pass all of that so that with all of my medical history it will be approved first time out? Let me know your thoughts. PC

I had to write 5 letters of appeal to get my husband's surgery appoved. Finally on the last letter he told me to state individually every medical appointment that involved obestiy. Then I listed every medical condition that he had that was related to obesity. I had our family physician write a letter stating the need for surgery from a medical aspect. Lastly I sent a copy of the letter all of my doctors, the insurance company, the Illinois Department of Regulations (attention Dept. Of Insurance), and my local senator. The reason I did the senator is if we had not gotten approved I was going to ask that they send a liason to talk with the dept. of insurance to help get it approved. We never had to go that far. That last letter did the trick. Each time they sent a letter of denial. I just keep sending a letter of appeal. The only thing I caution you on is if they ask you if you want a third party reviewer. Check to make sure that this does not stop all appeals. Or any new information in the future to pursue this surgery.

Angela, Thanks for your info. I think that I will do that the first try out. Send one to the DOI and one to my Senator (Just an FYI, Jesse Jckson Jr. is my Congressman, and he had the duo dendal, so maybe I'll send one to him as well). I'm hoping that since I have 2 insurances, my chances of atleast on of them approving will be great. However, I went to my primamry care doctor yestrday and he still didn't give me the referrral to the surgeon (although I still made the appt), he sent me to a dietician first because he said that I should try this on my own first. I was like Dr., I have been struggling with this most of my life. Don't get me wrong, I understand he wants me to be safe, but also he doesn't feel that pains and shortness of breath that I do. Blessing, PC

We thought that our family doctor was going to take the same approach. The bariatric center they we were going to was going to refer us to a different family doctor if they needed to. You may have to find a more supportive family doctor. Good Luck