:-@ :'( Denied! Anyone successfully Appeal Priority-Health?

I am upset that they denied me. They say that although my BMI is greater than or equal to 50, I do not have "obesity-related co-morbidities such as, significant cardiopulmonary disease, significant cardiac disease, hypertension requiring triple therapy, or diabetes requiring triple therapy or insulin therapy with Hgb A1C greater than 8.0." Apparently, my hypertension for 13 years with 1 oral therapy, my diabetes for 7 years with 1 oral therapy, and my high cholesterol for 7 years with 1 oral therapy must not be "obesity-related." Are they kidding me? I'm 32 years old. My PCP said I am much too young to have these diseases. I am ready to appeal. I am gathering my 30 consecutive weeks records of Weigh****chers from 2005 to submit. I am wondering what else I need. Any suggestions? If you can show me a sample appeal letter that would be good too. Tammi - Fightin' Mad

Tammi - sounds like you need a letter from your pcp stating that your health problems ARE obesity related. You should also do a search on the internet for some medical studies on obesity and diabetes, hypertension, etc... they're out there. I found some and sent that in with my appeal, along with my "estimated" cost of my health problems for the next 10 years to show them that in the long run, they'll be paying MORE to treat my conditions. Wishing you the best!!! Laurie Give me your email address and I'll send you a copy of my appeal letter.

Hi Laurie, Thanks, I would like to see your appeal letter. My eamial address is [email protected] I will do this research you suggest. I am pulling together as much info as I can. The insurance comapny did tell me that they have "approved" me to go to MMPC for medical weight management program, when I asked them what they cover, they told me, it will cost more than $2000 out of my pocket to go to the med weight loss program. I said, "basically you cover nothing then." She said "you will have co-pays and food costs that will equal more than $2000." She didn't say that they did or did not cover anything. Thanks in advance for sending me your appeal letter. Tammi

You've Got Mail!!!! Laurie

I'm so sorry you were denied. That's my biggest fear! But from what I'm reading in the posts, it's common. It seems some insurance companies deny you the first time no matter what. Don't give up. Listen to the advice of others and go through with the appeal. Please keep us updated on how it goes. Sending {{{{{{GOOD VIBES}}}}} your way!

Thanks Dee Dee. I was afraid this was going to happen. Priority-Health is very stringent with their requirements. Thank you for the support and encouragement. I will be working on the appeal this weekend. Best wishes for you in your journey.