letter to help with insurance fight!! help please

hello all.. i new here and in need of some help please.  i am meeting with a new doctor tomorrow and need to come up with a letter that we can forward onto the HAP HMO people .. it is to be from me basically saying why they should not deny me!!  does anyone out there have a copy of one that I could use as a guideline?  I would be so grateful...

thank you..kate

Try the wls for dummies book.  It has some sample letters in it.  My sister used that as a guide for her letter to hap and was ok'd the second time around.....good luck.

I had to go through this wiht HAP myself a few years back.  What worked for me was sending them a very detailed history, bascially in outline form. Plus I listed all pertinent family medical history, by who had what.  I told them the surgery was necessary to preserve my life.  I finally got approval, but my insurance canceled 2 weeks later due to my job being outsourced. 

Have you received a denial?   If you have not been denied, then you do not need a letter, it just has to go through the process.   It is a lot easier now with HAP than it was 2 years ago.  Do not assume that they are going to deny.  If they do, they will send you the appeal process, and then you would send your letter.   Good Luck.   You will be successful.    

thanks navymom-- just out of curiosity though- why do you say it is easier now than 2 years ago?  do you also have hap hmo?  if so could you tell me about your experience please,, thanks..

Yes, I had HAP/HMO.  I started the process in 2003, before it was a covered benefit with HAP.   In January of 2004, RNY became a covered benefit, but with very strict conditions to meet, and basically everybody was denied.   I was denied.   But I went through the appeal process and won the appeal, so I was able to have the surgery in June of 2004.   Since then, HAP has relaxed their strict conditions.   Most get approved on first try, providing they meet criteria.    BMI over 40, and comorbidities.  You wil have to use the Bariatric group at Henry Ford, but that is a good thing, because they are wonderful, and very talented. So your process will be that when you meet with you PCP, he will have to request a referral to Dr. Genaw or Dr. Carlin, if HAP denies the referral, THEN you can start the appeal process (Letter), but writing before will not preempt anything, because the right people will not read the letter.   The main thing with HAP is not to give up.   They respond to persistance.   HAP also paid for my tummy tuck.   Again, I had to appeal and be persistant, but they really do not make it impossible.   I am very grateful for the extra hoops to be very honest.  It validated how much I wanted to change my life, and I believe that this surgery should not be as easy as making a quick decision.   I hope this helps.    My advise is to get the process started by getting a good PCP behind you, and once the process starts, feel free to contact me, and I will be glad to help you through the steps.   Good Luck.    Carol

What navymom said.
You will be fine.
Positive vibes.
kp