Help!! PCOS - denied WLS - working on appeal

Ladies - I'm new to this board and I ran across a post a while ago but can't seem to find it again. Hoping someone can help me out. I spent 9 years in and out of dr's offices, Emergency Room and specialists offices -no one could tell me what was wrong with me.... 1 trip to the Mayo Clinic and 5 mins later they tell me you have PCOS - so I get put on metformin, told to lose weight, etc. etc. etc. You know the drill. So, after much research I decide to go forward with WLS - praying that the insurance company would approve it - alas they must live to DENY! Denied because they don't see WLS as medically necessary. Mind you my BMI is over 50 and I've been in and out of the hospital with pain associated with the PCOS, etc. What more do these people want from me? I need help preparing that wonderful appeal letter and would appreciate any information anyone can provide. Smiles

I have a copy of my appeal letter I can email to you if you would like. I had to appeal 2x before approval. Good luck! Meghan

Hi, if someone could email me a copy of their approval letter so I know what to write also, that would be great.

May I also have a copy of the appeal letter. Thanks Donna

Hi,

I noticed your post.  I was wondering if you could forward me a copy of your appeal letter.  I tried to have surgery about 18 months ago and was denied because it was excluded.  My company still refuses to add it to our policy.  But, I checked and the only wording I see on my benefits policy is an exclusion for 'Weight loss program".  It doesn't say anything about surgery.

Any advice you can give me, I would greatly appreciate!!!

Thank you,
Renee Kelsey
Omaha, NE

Hi,
I have denied by my insurance company and wondered if you could send me an appeal letter template (via PM/private message)...thank you!!

Sharon Bagalio

Your insurance company needs to be challenged on this because I have PCOS and was able to be banded. And I would post this on the main board and on each different type of WLS board, too. You will find that a lot of diabetic women on Metformin were able to get WLS. And a number are doing great. Some diabetic do a complete turnover, not even needing any meds to control their sugar after WLS. And that is a big savings to the insurance companies. Do include who your carrier is in your post to see if anyone else out there didn't have this roadblock and or appealed it and won. In the topic part, try to get everyone attention by using the word "denied" and "help." Also, go thru your entire medical history to establish any or medical conditions on top of being diabetic and a high BMI. That may give you an edge to getting WLS coverage by your carrier. Halina

Just wante dto mention that the original post was writtenin 2005 so the person you're asking may not check the forums anymore :)

On a side note, I was denied 3 times -- you just have to keep working with them sometimes.