Long Post: My Second Appeal Letter

Dear : I am enclosing documents that outline my need for surgery based on medical evidence, and necessity with the diagnosis of Morbid Obesity, which is not excluded in the benefits guide. Morbid obesity is clearly defined by the National Institute of Health, Center for Disease Control, Internal Revenue Services, and now by the United States Government Medicare Program (as of July 15, 2004) as a disease. California Procedural Codes (CPC) distinguish between treatment for obesity, and morbid obesity, and the treatment of the co-morbidities. Here's my problem: I am a 48 year old woman who has many health problems. I am morbidly obese; this means that I am more than 100 pounds overweight. My doctor has recommended I have gastric bypass surgery to help combat my health problems, and you have excluded and denied coverage of this surgery. This discrimination has condemned me to being excluded from access to medically necessary, quality care. Such discrimination and consequent denial of service is unacceptable. I am more than 40 percent overweight and I am likely to die prematurely as a result. My morbid obesity has been linked to several serious medical conditions, heart disease, and heart valve leakage exacerbated by the weight. I suffer from GERD which is likely to lead to Esophageal erosion and cancer. I have high blood pressure, which puts me at a greater risk of stroke. I am more likely than a non-obese women to die from cancer of the gallbladder, breast, uterus, cervix and ovaries. Given my medical conditions and weight, obesity surgery is the appropriate treatment. There is no legal or scientific reason for this denial especially when you will treat Alcoholism, Anorexia, Drug Abuse, and allow Penile Implants. This denial of service is as inappropriate as one that might be based upon my race, gender or religious preference. You would not deny services for the treatment of diseases related to morbid obesity i.e. heart attack, stroke, GERD, why are you refusing to treat the disease? I suffer from a severe medical illness that has caused me severe disability and has an excellent chance of being cured by a three-night stay in the hospital. My disease is frequently lethal and denial of treatment is simply not acceptable in this case because it is obviously not based upon reasonable scientific knowledge. It is based upon discrimination and mistaken opinion. Scientific opinion in the form of the many consensus conferences and medical literature all recommend surgery. This exclusion is founded on bias and not upon up-to-date scientific information. It should be summarily reversed. Given the widely recognized morbidity of severe obesity many expert groups have reviewed available data to provide guidelines for the treatment of obesity. The results of all of these analyzes have been the same. Surgery is recommended for patients who are severely overweight (BMI > 40). I have a BMI of 41 and thus clearly fit these guidelines. These are the conclusions of the NIH Consensus panel, the American Association of Endocrinologists, the American Diabetic Association, the former Surgeon General C. Everett Koops group "Shape Up! America", Johns Hopkins, the Mayo Clinic and others. All recommend surgery in obese patients with a body mass of more than 40 or with a body mass index of more than 35 with significant other associated medical illnesses. In a study by the department of Psychology, Yale University, New Haven, Connecticut, April 25, 2001 they found that obese persons are the last acceptable targets of discrimination, and this exclusion is clearly discriminatory. Obesity interferes with my performance of the normal and routine tasks of daily living, such as work, household tasks and recreation. I have trouble doing anything that requires me to be on my feet. I have trouble climbing stairs. I suffer from dyspnea on exertion related to my obesity. Obesity limits my ability to walk, climb stairs or to participate in normal activities that require anything beyond minimal effort. I have degenerative joint disease, I also have severe back pain (Locke Facet Syndrome) and am unable to do many of the things most people take for granted. I have tried many diets over the past ten years, and have not been successful. My doctor feels the condition of my back and knee make it virtually impossible for me to lose weight on my own, as I am unable to exercise at all. High blood pressure, high cholesterol, obesity, and cancer run in my family. The known surgeries I will need to have if I don't lose weight will cost far more than the surgery I am requesting now. Morbid obesity is an extreme health hazard that is rarely the result of an aberrant moral problem or addictive behavior. There is an extremely high incidence of failure to sustain even a 10 per cent long-term weight loss in morbidly obese patients with any form of non-operative treatment. Bariatric surgery, on the other hand, has been shown to be the most effective means to aid in management of the life-threatening complications and severe degenerative problems of morbid obesity. It is indicated due to the ineffectiveness of non-operative treatment methods for morbid obesity, the high risk of untreated morbid obesity, and the safety and effectiveness of operative treatment. Safe, effective bariatric operative procedures increase the longevity, productivity and quality of life in morbidly obese patients. My weight severely impairs the quality of my life. I believe that the gastric bypass surgery recommended by my personal care physician and my surgeon will alleviate my coexisting medical conditions, increase my overall life expectancy and cut down on future health-related costs. I signed up for your health plan because it was the only plan available to me that would allow me to continue using the physician who has been treating me, and is fully aware of my co-morbidities. As you know, health care is not cheap. I've been very dissatisfied with the way < >looks at obesity. Unfortunately, I don't have the option of shopping around for health care, and by the time I am eligible for new insurance I may have already lost my battle, and my life. This is what I'm asking < . to reconsider. Based on the information provided above, I would like < > self insured plan through Untied Health Care (who by the way recognizes the need for Gastric Bypass, and routinely approves this life saving surgery) to realize that obesity is a disease that should be treated. Do not just treat the results of obesity (high blood pressure, sleep apnea, diabetes, etc.) but treat the disease itself. < > plan treats: alcoholism, mental health issues, Anorexia, drug abuse, and erectile dysfunction...why exclude the disease obesity? I am appealing the denial to my first request for approval. I would like < > and United Healthcare to do the right thing, approve my request for surgery. Treat my illness to save my life. I hope you can resolve this problem quickly. If not, I would like to request mediation, and or arbitration as soon as possible. Sincerely, Enclosures

I LIKE IT! Mind if I use it as a model on my own appeal? (different insurance) Sandi (AL)

what happened with the first appeal , this one is awesome. i am in the process of appealing now. but this one is great