example of an appeal letter?

Dear Sir or Madam,

This letter is to appeal your denial for RNY gastric bypass surgery referral that I received on January 20, 2006. (Diagnosis Code 278.01 Procedure Code 43847).

I was referred for this surgery by my PCP, who is very concerned about my health because of my severe morbid obesity. I am a 40 year old, morbidly obese female who is 5 feet, 5 inches tall and weigh, at this time, 313 lbs., giving me a body mass index of 52.09 The body mass index is calculated by dividing a person's weight in kilograms by their height in meters squared. When a man's BMI is over 27.8, or woman's exceeds 27.3, that person is considered obese. The degree of obesity associated with a particular BMI ranges from mild obesity at a BMI near 27, moderate obesity at a BMI between 27–30, severe obesity at 30–35, to very severe obesity for patients with a BMI of 40 or greater^1,2,3. Therefore, I may be classified as being very severely obese. The annual number of deaths in attributable to obesity has been estimated to be 300,000 deaths per year^4,5. With my abnormally high BMI, I am at an estimated 190 percent increased risk of death at my present weight.

I am having significant adverse symptoms from my obesity. I have difficulty standing or walking for any length of time. I have difficulty performing my daily activities, and in participating with my family in recreational activities. I have severe pain of my weight-bearing back, joints and feet. I now have bone spurs on both my feet that are aggravated by my weight as well as Plantar Fasciitis. An increase in body weight adds trauma to weight bearing joints and excess body weight is a major predictor of osteoarthritis of the knees. This is a mechanical problem and not a metabolic one. Weight loss will markedly decrease the chance of developing osteoarthritis.

I also suffer from shortness of breath and I have exercise induced asthma. Being as obese as I am, almost everything I do is considered exercise by my body. I cannot go anywhere without my inhaler close by. Breathing normal is a thing of the past. Constantly out of breath is a way of life. A sad way of life. There are several abnormalities in pulmonary function in obese individuals. At one extreme are patients with so-called Pickwickian syndrome, or the obesity-hypoventilation syndrome, which is characterized by somnolence and hypoventilation; it eventually leads to cor pulmonale. In patients who are less obese, there is a fairly uniform decrease in expiratory reserve volume and a tendency to reduction in all lung volumes. A low maximum rate of voluntary ventilation and venous admixture is also present. As an individual becomes more obese, the muscular work required for ventilation increases. In addition, respiratory muscles may not function normally in obese individuals.

Because of my extensive GERD, (Gastroesophageal Reflux Disease), pains and aches in my back, shoulders (extra large breasts) and legs I have difficulty sleeping, and therefore, am fatigued and tired during the day. This surgery usually cures acid reflux and sleep disturbances.

I have borderline Diabetes at this point. Diabetes is a common concomitant of obesity.

I have made many, many attempts to lose weight. This has gone my entire life. As a chubby child, I was bribed to lose “just 10 pounds” and I’ll buy this or that for you, by my father and grandparents. These scenarios always ended in disappointment for us all because I did not totally succeed. As you can imagine, it caused substantial pain and severe depression in me. I have done Jenny Craig , Weigh****chers, Carnation, Herbalife, grapefruit, Atkins, Jane Fonda , Richard Simmons , and many more. With each and every one of these attempts I gave 100%, only to fail again and again. I was put on medications by my doctor to help lose weight. I have been put on medications over and over again. I would lose some weight then gain it all back, and more. I have also tried many exercise programs. From personal trainers to large and well named gyms. My biggest and longest success was from the HMR system and was medically supervised during the 2.5 years of the program. I was 120# successful. It was exhilarating. I did the classes, did the exercise and ate well. I loved me and my life. Then the slow creep started happening. I even tried non conventional ways out of desperation and still no long term success. As you can see, I have spent most of my childhood and all of my adult life trying to lose weight. I am now at the very edge of disability and am at a point where everything is an effort. The obese individual has functional impairment in the activities of daily living. This dysfunction impacts sleep, recreation, work and social interactions.

I have studied, researched and learned about the weight loss surgeries for the last 3 years. I do not take this decision lightly. I know the risks involved with the surgery as well as the risk if I do not have it. I have made this decision to go forth with the surgery on my own with education to back me up. I have my PCP behind me as well as my Psychologist. They believe this to be extremely beneficial for me physically and emotionally. They both have written letters of recommendation for me to have this procedure.

Economic costs of Obesity: Obesity has been shown to directly increase health care costs. In an article in the March 9, 1998 issue of the Archives of Internal Medicine 17, 118 members of the Kaiser Permenente Medical Care Program were studied to determine the association between body fatness and health care costs. The results showed that patients with BMIs greater than 30 had a 2.4 times greater risk for increased inpatient and outpatient costs than patients with BMIs under 30.

Indirect costs: Americans spend an additional $33 billion dollars annually on weight-reduction products and services, including diet foods, products, and programs. Most of these expenditures, as is evidenced in this case, are not effective. Rather it can expected that they will continue to gain weight and the costs of co-morbid conditions, including the ones they already have and ones they surely will acquire as time goes on, will far outweigh the costs of gastric bypass surgery that we are asking you to please approve for me.

I am a 40 year old woman, with a loving and supportive husband. I have two active step-children and two wonderful and beautiful teenage children that I care about and want to be more involved in their lives and hobbies. At this point I am reduced to being the “fat show mom” at the horse shows and rides. The one that pumps everyone up with positive things, meanwhile on a number of medications for sever depression because of the shame, and embarrassment I have in myself and for my family because of my obesity. Just doing my regular chores around the hobby farm is beyond exhausting anymore and even more painful.

As you can see I have exhausted all the traditional ways to lose weight. The gastric bypass is an approved and proven means to permanently lose weight. I 100%, thouroughly, physically and emotionally am ready for this in my life. I know all the risks involved. I have started to attend support meetings to help me be a better patient and success. I continue to have my counseling appointments. I feel that mental health is just as important, if not more, because most of what obese people have problems with are on the mental side of dealing with food, weight, exercise and all the other facets to this huge problem. Please, I am just short of begging you for my life, Please approve this surgery for me. Thank you.

Ever sincerely,