OT - Plz help!!

Plz Help - Appeal letter Hello all, Well I was denied last week my surgery through insurance (CTCARE). except, the said they would cover it, until they found out my employer has an exclusion (since 1/1/03) not to cover weight loss surgeries. I would be okay with that, but I know of at least 4 people in my company who had this surgery since 2003 and was paid for through insurance. I talked to my benefit dept and they said they will not cover it, etc..i questioned them on the other 4 people and they told me they cannot discuss them. So now I am told to send an appeal letter to my insurance company and my employer for the surgery. Unfortunately I am not that great at writing essays so I was hoping anyone who had gone through this if you can help me write something, or email me your appeal letter? I am so upset about this, especially since I verified with insurance 2 times before I had everything done that they would cover it, and the fact that people I know had it done w/out a problem. I wonder if its a 'sign' that I shouldnt have it done, and do you think I can evenutally get it paid for w/ insurance? thanks so much in advance!! Dawn

Hey Dawn, First of all, did these other people have a second insurance (like their spouse's or partners?) Secondly, have you spoken with them and asked them how they got it done? These people are probably your best source of info on what to say in your appeal letter. Also, I believe there is an area on OH to help you with just this type of letter. Search it out. Thirdly, don't start thinking of signs. Think positive, have a good attitude and things will fall in place. Good luck! Carol

Hi Dawn I'm sorry to hear about the denial. Insurance policies change every year. Usually if your employer did not elect to include that as a part of you benefit package then it's probably a losing battle. With that said, though, it doesn't hurt to consult an atty. I did when I was denied. I used an obesity advocate atty, Walter Lindstrom. You can find him online. If you can't, email me and I will give you the info. He wrote an appeal letter for me. My employer did not have as an exclusion, howevever. Either way, it's worth a try. Good luck.

Thanks... Its not even a new change to my insurance though..its the claim that they havent covered it for 2 years now (my employer) and yet i know at least 2 people who have had it done...can you email me his info plz? thanks!

Sure, I'll get it to you today.

Hey sweetie, I am sorry to hear about your struggle. If I were you, I would requst to see the details regarding your insurance in writing. If there is an exclusion or if it's not covered, then it should be in writing. If not, then I would seek assistance from someone in your HR. Luckily, I did not have to deal with an appeal. I am sure if you posted something in the main message boards asking for sample appeal letters, people would be more than happy to give you a copy. I will provide you the letter I wrote for when they submitted to my insurance for approval. Maybe some of these parts can help you. I wish you luck dear. Keep us updated.