writing a letter to insurance company

my insurance co denied me....now my surgeon recommends that i write a letter to my insurance company basically to plead my case as to why i need gastric bypass surgery...i have tricare standard and of course their policy is that u have to be 100 lbs overweight...and of course i'm not...i'm only bout 82 lbs overweight but i have co morbities....has anyone had to write a letter to their insurance co before??? if so what did u say and what was the outcome??

I've heard both outcomes with a Tricare denial. I wish I could help but I didn't use Tricare. Perhaps others will chime in.

Good luck and don't give up. Write about and stress your comorbidities is all I know to do. Tricare has rules written back in the dark ages and I sure don't understand them.

--gina

I got lucky with Tricare Prime, I know with prime you had to have at least a BMI of 35 with comorbities in order to be approved, 40 with out, I was 42 with co morbities so I had no problems. Triare is so hard to navigate and even more confusing to talk to them. DId they give you a reason?

they said because i wasn't 100 lbs overweight...which i called tricare before i started everything and asked them.."i know i'm not 100 lbs overweight but i do have comorbities should i go ahead and send it through or will it get denied" they said i shouldn't have a problem so i went ahead and saw my surgeon and everything...then i get denied...which my surgeon said they prob would because my bmi is only 37 but that he would cud pushing it through cuz of my helath issues...so i guess we will see...tricare is anybodys guess...

Link to some links to apeal letters. www.obesityhelp.com/forums/ds/4454968/appeal-letters/  Also, Larra is a doc and she posted in the thread. She says to stress your comorbidities.

--gina

Here is the letter I prepared for my doctor's signature after I was initially denied.  You can change to reflect your specific issues.  I hope it helps, I was approved right after they received.   Just copy to word.

August 12, 2010 Re:  DOB:    To Whom It May Concern:   This letter is in support of bariatric surgery for __________________. She has had a life long struggle with obesity and has attempted numerous methods of weight management without lasting results for over six years that she has been a patient with us. She has tried various weight loss methods, including Weigh****chers, Atkins, Liquid Protein shakes, GNC’s Release program, The South Beach Diet, Slim Fast, and the 6-week body makeover. She has participated in exercise programs including two memberships with CURVES, the most recent membership started in January of 2009 and still participating. ___________ has met several times with our dietician, and has followed recommendations for her meals. She has lost weight in some of these programs only to regain the weight and more each time. She has a strong family history of obesity, Type II diabetes, and heart disease. At this time, ______ is extremely committed to pursuing bariatric surgery. __________has been diagnosed with obesity, along with co-morbidities of Type II diabetes and acid reflux.   Her current weight is 235 pounds and height of 5’6". Her BMI is 37.9. In the past couple of years her weight has fluctuated between 216 and 235 pounds in our office. I believe that _______ is extremely motivated and knowledgeable about bariatric surgery and committed to making this a lifelong change. Her ideal body weight and weight loss goal is approximately 130 pounds. She is currently taking several medications to manage her Type II diabetes, cholesterol levels, blood pressure, acid reflux and depression.   She has no known allergies.   I feel that __________ has exhausted all of the options available to her other than weight loss surgery. I find this surgery to be a medical necessity and have referred her to ____________, M.D., who specializes in laparoscopic Roux-en-Y gastric bypass surgery and offers extensive pre and post operative follow-up care.  __________ is affiliated with a Blue Cross Blue Shield Blue Distinction Center where the surgery would be performed.    Should you have any questions regarding this recommendation, please feel free to contact me.   Sincerely,

I used the similiar letter. I got mine off the obesity site and my doc was way impressed. It worked and I got my surgery.

Good luck to you.