Appeal and Indiana Law

(deactivated member)
on 8/4/08 4:30 am
My appeal was denied because I have not had a BMI of 40 for 5 years.  However, I have had a BMI of 35 with co-morbitities for 5 years and I thought that Indiana State Law considered that morbidly obese.  Does anyone know if I have a case?  Should I hire an attorney and appeal again based on this only??? 
Thanks for any advice.
Sherri
Annette C.
on 8/4/08 5:30 am - Danville, IN
I don't know about the state law or if it defines what is morbidly obese.  However, in my case I had a short period during my 5 year history where my BMI dipped to 34 (it was 39 at the time of my approval).  My argument in my appeal was that I could stick to a diet plan long enough to lose weight, my problem was in maintaining that lowered weight.  I always gained it back and usually a few pounds extra. 

You can continue to appeal, either on your own or with the aid of an attorney.  Be sure to keep your appeal letter to the facts, with little or no emotion as emotion has no effect on an insurance company. 

You should state your weight as fact, your weight loss history as evidence that you can stick with a program, list your co-morbidities along with treatment and emphasize the cost of those illnesses and the endless (and ever increasing) cost to the insurance company to treat them. 

List quality of life issues without emotion.  Example:  I am unable to accompany my family on hikes in the state park.  I am unable to fly on commercial airlines.  I am unable to see to private personal hygiene without assistance. I am unable to enjoy a normal sexual relationship with my husband.  etc...

Do not say how these limitations make you feel...they don't care. 

Do list all medications, doctor visits, all aches and pains whether treated or not.  Overwhelm them with information, even things you may think are too personal.

Best wishes on a successful appeal.  Remember most surgeries are approved on appeal.  Sticking with the appeal process just goes to prove your point that you are dedicated to the surgery.

Annette 
I can eat as much as I want...I just don't want much.
I'm ashamed of what I did for a Klondike bar...

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