Help on a letter to insurance company.
I'm hearing that there has to be a letter from me to insurance company about why I want surgery. Does anyone have any hints to use that will help convince the insurance company to approve it. I would like to get approved on the first go around. Any suggestions as to what to include?
HELP?? I"m trying to plan ahead some and save time. Would appreciate any suggestions or a sample letter that worked. Thanks. jg
My insurance company is Pacificare by the way
Hi judith! oh boy, do I remember THOSE!! I was asked to sumit a personal letter with EACH appeal that I had....so, ill just let you in on MY experience!! first thing is you want them to know about your co morbidities and how THOSE are affecting your life~~if they are getting worse, how out of breath you are, whatever they may be!! I really think this is important!! they need to know how it affects your life. Go into detail!!! they need to see you as a real person struggling with these issues, not a number!! I even read on here where one woman sent a timeline of pictures with hers...i found that interesting!!! Tell them how it is affecting your family; i have small children and told how hard it is for me to take care of them. Tell how frustrated you are and how many diets you've tried, and tell them how diets have only added to your weight not taken from it. I hope my suggestions help you!! and if you pray, PRAY about it!! HUggZzz and good luck!! traci
Here is a copy of my letter:
To Whom It May Concern:
My name is Leslie Draper, and I am 29 years old. I am the mother of two young children, Tatum age 3.5 and Avery age 22 months. I am also a person living with the disease multiple sclerosis.
Almost a decade ago, my journey with MS began with strange and unpredictable symptoms of numb hands and blurry vision. Ever since that time, my life has been a series of battles, which corresponded with relapses and remissions in my MS. Life with MS is a daily battle, and there is never a break from the struggle. Even on good days, the threat of the MonSter looms in the background.
For the last several months, my Multiple Sclerosis has progressively gotten worse. The painful and debilitating muscle spasms make movement difficult, and the indescribable fatigue makes even daily living tasks stressful and challenging.
I am struggling now more than ever, and I can honestly say that I am in "survival" mode. At times, a single day is too much to handle all at once. I divide my day into segments and primarily focus on making it from morning to afternoon and then from afternoon to evening.
Unfortunately, my struggle with MS is seriously compounded by the fact I am morbidly obese. At 5'4, I weigh 260 lbs. My BMI is 44.6. My struggle with my weight has been a life long battle. When I graduated from high school, I was a size 18. For the last four years, I have been a size 24/26. I have tried every diet under the sun. The most weight I have ever lost was while I took the diet drug phen phen more than ten years ago. I lost a total of thirty pounds, but I gained back more than fifty when I discontinued taking the drug. (The clinic where I had been prescribed the drug has since closed. I have no way to get those records.)
My PCP has made a referral for me to see Dr. Floyd, a surgeon who specializes in surgical weight loss, including the roux en y gastric bypass surgery. My PCP is in support of me having this surgery. At this point, my health is in a state of urgency and deterioration. My mobility is limited and starting to fail. I have fallen four times since April. The momentum from a 260 lb body falling is sure to cause both pain and injury. Each fall leaves me a little more rigid and a little less mobile.
I am losing my battle against the MonSter, and I know that my weight is a contributing factor. I am absolutely begging for Pacificare to approve my surgery. This is not a cosmetic request. This request is 100% from a mother who wants to be able to walk to the park with her children and to be able to maneuver safely around the house. This request is from a woman and mother who struggles everyday with a debilitating and chronic illness that is slowly stealing her ability to live life. I have a much, much better chance at retaining my mobility if I lose at least 100 lbs.
The physical burden of carrying 260 lbs would be challenging for a regular person. The energy and muscle strength it requires to live life at 260 lbs would be difficult for a healthy person, but I am not a healthy person. I am a person with MS.
I am begging for this surgery, not only for myself, but also for my children. At least, with this surgery, I can fight back, and I can fight for my mobility and life.
Sincerely,
Leslie Draper
YW judith...the letters were really hard for me; and I also had a phone conference on my last 2nd level appeal which i had to pretty much do the same thing, BUT ON THE DANG PHONE!! with people i did NOT know....and even though this surgery is MUCH needed it was still so hard for me to bare my soul....but you really have to; like leslies beautiful letter....its hard, but they MUST see you as a person. HUUGgZzzz and best wishes to you!!! 
I will try to find it but someone from the main board has an insurance letter that even contains co-morbidities and their codes as well as goes into very specific details. I worked in the legal profession for a long time and the letter looks as if an attorney drafted it. As soon as i find that profile i'll post it here for you to look at also.
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