Can I get your expert opinons please!!!!!!!!

Hi all, well I got my denial right before Easter, how wonderful is that. Anyway, I have written up an appeal and it is posted in my profile, could I please get some of you to look at it and tell me what you think. Should I add stuff or take stuff out. All your opinions count to me. Thanks so much.

Kim, I read your letter, the question I have is do you have any kind of documented weight loss attempts? Weigh****chers, Atkins etc. With today's insurance coverages I don't think that you will be successful without some type of documentation. I didn't see that in your letter. The letter you wrote is good I just question the weight loss documentation also. Jeanne

I agree with Jeanne, but also you need letters from both PCP's that support the need for gastric bypass surgery. You also need to document your current weight, BMI, and any co-morbidities that you might have - i.e. high blood pressure, sleep apena, diabetes (or border line) or other health problems that you might have.

I agree with both the other responses. If they told you that you were denied because you did not meet the 18 months physician/professionally supervised weight loss attempts, you have to prove to them that you have (if you have). You would do that with documentation from either your PCP(s) or a professional program (ie.weigh****chers). Although your letter is good, it still doesn't address the real reason why you were denied and will take you no where. It only delays the process. Hang in there and keep on working on it. You may want to ask them to send you a copy of the criteria for the procedure so you can see it in black and white. That will give you a clear picture of what you are working with. Good Luck!