APPEAL HELP!! DO I NEED AN ATTORNEY?

I just found out last week that I was denied for the surgery because of documentation. Then my surgery nurse submitted more records (6 months) and they still denied me for documentation! So, now I have requested an appeal, but not sure if it will do any good. I think the insurance is playing russian roulette because there is a good chance that my hubby's company will be dropping WLS coverage in January. Should I send a letter from an attorney with my appeal? Anyone know how much that would cost? Will it do any good? I am only allowed one appeal and then I have to resubmit the entire claim over again. I may not have 6 more months to fulfill their requirements, AGAIN. What should I do? I cannot believe they denied me anyway because I gave them 8 years of records documenting morbid obesity and other health problems, along with 3 letters of recommendation, one of which was from a doctor who has been treating me for over 4 years. I am 5'2" and weigh 255lbs. I have diabetes, high cholesterol, PCOS, infertility, abnormal menst. cycles, sleep apnea and a BMI of 47! How in the world could they deny me? I would love to know what you guys think I should do. Thanks so much, Erica

Id ask them for specifics on what they are needing as far as documentation. Ask them to mail you the specifics in writing. Also Im not sure what good a letter from an attorney might do it couldn't hurt anything but not to sure how it would change the appeal decission. Good luck. *huggles*

Hi Erica, I haven't had to deal with the insurance part, but then since I have medicare/blue care I am not overly worried. I am 5'3" 294 #, have been in a wheelchair for a year. I have high risk sleep apnea, mental health problems, degenerative arthritis, osteoporosis, allergies, can barely breath, and have fluid retention in my feet, and fluids around my heart and lungs. I do understand your frustration. One lady on this board did the following, she made copies of pictures before being obese, and what she looks like now being obese. Her older daughters, husband, her family, and friends all wrote letters for the insurance, she was approved. It makes sense having those who love you write letters on your behalf. In the event that I have to go that route, my three dearest friends who has known me for 28 years, has seen me go from 110 to 294, are planning on writing letters on my behalf. My oldest son will write a letter. My parents aren't if favor that I have this surgery, but are there for me. Two of my sisters are there for letters if I need them, and I already have the pictures ready to scan and print out if needed. Find out what documentation they want, and go the extra mile with the family letters and photos. Best of luck sweetie, you will get approved, it may not be today or tomorrow and it depends on the insurance, but you will get your surgery. At the top of the page is a site that says find a doc and insurers. Check out the Dr. you want and see what patients have said about their insurances, that approved, how many appeals, and what ones the Doc takes. Keeps us posted. Kathy

Erica, Ask specifically what they need and then try to get it to them. If you want to talk to an attorney go to obesitylaw.com. They will help you and let you know over the phone what you can do. I am going through an appeal right now, but mine is for an exclusion. Chances are you will not need an attorney. Be firm and ask for specifics. They have to tell you what you need. Take care and good luck Nicky

ericka I cant say exactly what you would need but if all your looking for is a letter on legal letterhead check out my profile . I do good legal mumbo jumbo letters(g). I dont have much time for anything else but do like doing the letters for people as I know what I had to go through. I dont charge much and probably would not neccessarily suggest you use an atty yet but for your explanation that you might lose your ins in 6 months, that sort of changes things and makes pulling out all the guns neccessary sooner. If you want to discuss it you can reach me through email, or go to Diminishing divas and drop me a line from there. Even if you dont use me, feel free to use anything from my profile ... my experience with other WLs patients is that it is persistance and perserverance and a good dose of patience that helps the most. The legal letters do seem to have a good effect especially on INs Co's that are just throwing up road blocks in the hope you will just give up. I have my fingers crossed for you. Joe