APPEAL HELP NEEDED KMART SHOPPERS

Hi, Me again... OK, so now I begin the undaunting task of continuing to jump through Blue Cross Blue Shield's hoops, and I need some advice from some of you alumni's out there that have already walked in my tired old shoes. What do I need to include in my appeal letter? Does it help to include pictures? Should my family write a letter to include as well? How do I go about finding out what all my surgeons office sent to BCBS? Hugs, Carol

Carol, It's hard to help with the appeal if we don't know why they denied you. You have to cover every issue that they listed as a reason why they gave you a denial. Let us know the reasons maybe then we can help with the appeal letter. Anne

they want more supporting documentation...and thats all they said...supporting documentation of what?? My diet attempts? That I really need the surgery? That my PCP recommends this??? I haven't got a clue...

Carol, I included a personal letter from myself and a complete diet history. Usually they wanted at least five years, but i started at age 8 until present(age 34). I also included two letters from my doctors stating this surgery was needed. I included pictures too. I was denied and filed a secon appeal and was denied there too. My policy has a written exclusion though. They state they won't pay for any kind of weight loss surgery. I now have the choice of going through arbitration. I also have BC/BS of TN. Good luck and let me know how things go. Nicky([email protected])

Thanks Monique, I had written a letter (which I gave to my Surgeons office and I thought they would automatically include) and also my diet history (once again, I would think the surgeons office would include all this) but now I am going to write a more detailed letter, along with letters from my family and life long friends, pictures of myself, and a letter from my sleep doctor. I am hoping that denial is "run of the mill" for my insurance as my plan does not have a written exclusion, just that they won't pay for any NON surgical weight loss programs...go figure...Thanks again, Carol

Document in a very professional way. List all diet attempts and dates -- even if dates are approximate. List even things like Dexatrim, Metabolite, etc. Document as far back as you can your weight. I did this by obtaining copies of my medical record from my PCP. They weigh you every office visit. Make a chart listing date weighed, the amount you weighed and BMI, put all in date order. List all comorbidities. A support letter from your PCP is EXTREMELY important. Pictures are helpful. Your surgeon's office should tell you everything they sent -- where are you having surgery? Keep a copy of everything you send -- so you are prepared if anything "gets lost".

Hi Carol, you really need to shop around and get away from Kmarts. I am having all my Dr.'s write letters for me once I find a surgeon who will take me on. Hopefullly when I see this surgeon on Monday, I'll have a Dr. But I have already been organizing my letter just in case. My friends, some of my family (some are against the surgery) are writing letters. I want to have all this ready just to be on the safe side. All I can do is pray you will be approved. With love Kathy Best of luck in writing and submitting your letters.

carol visit my profile and If I can help just contact me. I have several letters up on my profile and if you want to I can write a legal letter to your ins co. I know with BCBS my appeals got nowhere and fell on deaf ears until I started using my legal letterhead to get their attention there are never any guarantees but every little bit helps in my opinion.