question about writing an appeal

Iman M.
on 7/5/08 3:04 am - Arlington, VA
Hi All -  I have been lurking for some time and enjoying learning frome everyones experiences. In May my insurance (CareFirst BCBS - PPO) denied my request for RNY surgery by Bayview-John Hopkins (Dr. Steele) due to not having 6 month of diet history in the past two years.  I am not 170 lbs over weight becasue I have not tried to diet.  So I have been going to my PCP and weigh****cher so here is what I have.  In 2006 - Jenny Craig - I have documented 3 Months (August, Sept, Oct) and In 2008 - WW  -I have documented 3 month (April, May, June) and will continue to go until I get approved.  Also, my PCP has put me on medication for high blood pressure, and I am taking metformin for insulin resistance related to PCOS.  My question is - do I write the appeal myself and mail it t the insurance company or do I give Dr. Steele's office this information and have them submit??? I feel more in control if I do it but at the same token, want to make sure I get approved.   Anyone have experience writting an appeal letter? If so, I can use some words of wisdom and what to do and not to do.   Thanks,  Iman
Cira S.
on 7/5/08 4:54 am - Charles Town , WV
Hello Iman, I am sorry your dr's office didn't figure out that your insurance required a 6 months consecutive months of supervised visits.  That suucks! How are you documenting the months now? By the way I know your dr. should be able to tell you exactly what you need to do so that the appeal is goes right.  I really do not know what you should do but please post on this forum and maybe someone there can help you. http://www.obesityhelp.com/forums/insurance/ Good luck and I hope you get approved.

I am who I am and accept my feelings wholeheartedly.
Those that mind don't matter, and those that matter don't mind.

Cira 249/144.0 current/goal 154/ 5'3" 10 lbs below my Dr's goal
100Cira-1.jpg picture by negra266

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