Appeal Advice / denied over 1 lb!

VallartaTiffany
on 7/10/09 8:10 am

I have been sitting on my appeal for almost two months and I'm finally out of my rut and ready to take on my insurance company/HR department. 

My denial was based on my BMI only, pre-existing conditions (sleep apnea) are not even considered.  The requirements of insurance were 5 years of a BMI of 40 or more.  So of the 5 years of weight history required 3 were 40+, the other two were 39.9 and 39.2.  Myself and the surgeons office did not realize this until we received the denial, our understanding was BMI of 35 plus one pre-existing condition. In my case sleep apnea. 

I have one additional weight history to submit with my appeal, but it also comes to a 39.9 BMI.  This is because of 1 lb that I was denied, if I weighed 1 lb heavier on these visits I would have been approved.  Which just makes me ill.

I have done searches on the internet for advice on writing the appeal, some advice to keep it short and to the facts, others include facts, statistics, articles....I'm not sure what to include.  I'm turning here for hopefully some direction.  I feel as though I'm being penalized for making an attempt to loose weight during these times.

Do I have a case? 

Thank you :)

Tiffany
 

rebeccaford
on 7/10/09 11:55 am - Honolulu, HI
HI Tiffany...I wish I had some kind of advice for you.  I can empathize with you...that totally sucks.  Good luck and keep us posted.
Rebecca
3/23/2003 Open VBG
4/6/2009 Open RNY Revision
6/08/2011  - I've lost 155 lbs! size 8-10




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