Filing a Grievance help!

My surgeons office told me to file a grievance with my insurance company (they denied me first for something I could fix, now they Are denying my because my BMI is 38.5 and I don't have life threatening co-morbiditys) But I am, clearly, horrible with words.  Does anyone know what I should say, mention or even format this? I'm so lost, and a little over whelmed :(

Please help!

Check out the website for the insurance commissioner in your state.  There may be information on the site, such as a sample grievance form that you can use as a "go by."  If not, give them a call and see what they suggest.  The second source you can consult is the insurance company's own website.  They should have information for their insureds on how to file grievances and/or pursue appeals (also check any denial letter you received; I have Aetna, and they clearly state how to appeal a decision in the letter itself).  You might also ask your surgeon's office if they have a sample you could use, as I'm sure they've had other patients who have been in similar situations.

Try to make your grievance clear and concise, and be prepared to include any copies of medical records, etc. that show your BMI.  Good luck to you!

Hello,
I just got  denial letter and I was wondering how your grievance letter went? Its been about 3 weeks since you posted your questions. Any information will help.

I sat in my car and cried holding that letter! The "medical director" who denied me after "carefully reviewing" my records decided that I have a "Lack of Medical Necessity"!! What do I do now?!

Thanks!

That is the exact same thing mine said! I just actually received my letter from them saying they are denying me AGAIN because I lack the medical necessity for them to cover my surgery - this is all over five pounds too!!! So! I'm going to talk to my surgeon about (this is a sin I know) gaining the five pounds and starting over from scratch (if it's allowed). But my letter got me no where but back to where I started. Depending on why they are saying it's not necessary I would probably suggest the same, only because I've waited 3 months fighting after a year of working for it and it's just too much time that I'm worried I don't have.

Best of luck though in whatever path you take!