writing appeal letter

I need to write an appeal letter to my insurance company UHC Choise Plus. Denied on the basis of exclusion in my benefits coverage. I am 31 and have a BMI of 49. I dont have any co-morbidities but my parents have many. which is why i want the surgery to reduce my risk and become healthier. MY mom contacted her lawyer, but he wont write a letter until ive already appealed and been denied again. so now i dont know what to put in this letter. Its been medally proven i need the surgery so thats not my issue. What should I say to appeal an exclusion in my benfits. which FYI myself and my surgeons office were told on numerous occassions i had the coverage. any suggestions woulkd be greatly appreciated. i received my letter last week and would like to get my appeal in as soon as possible.

Unfortunately, if your specific plan excludes WLS there is nothing the actual insurance company can do.  Employers pay an extra premium to have that service/benefit on their plans.  You may want to try and talk to your HR dept and see if they would be willing to put a "rider" on your plan specifically for you.  You may have to pay that extra premium out of pocket but it will definitely be a lot cheaper than what you would have to pay for the whole surgery out of pocket.  Formerly working for 2 insurance companies, this is the thing you hear the most.  People don't realize that its your actual employer that choses the plans and what they want to pay for.  if thats the case I would talk directly to your HR. rep.

Hey Hun!!!    If you want, send me a message with your email and I can forward a copy of my appeal letter to you since we have dealt with the exact same situation. I spoke to my HR manager who told me that a rider is not available. So I will see how the appeal goes from here! I called UHC today and was told a letter was mailed out yesterday with a first decision so we will see where this goes from here! I will def keep you updated! My advice would be double check the fax #'s bc I had a hard time making sure they had received my appeal letter and I would call EVERY day to check to make sure they did. I wish you the best of luck! Nicole

Unfortunately, your wasting your time, if there is an exclusion the insurance company cannot overturn it, they administer the policy for your employer.  I work for a major insurance company and have never seen anything overturned where there was  an exclusion.  I wish you much success, maybe talk to your HR dept.  Good luck.