letter of appeal
I am trying to write my first letter of appeal. My insurance company is denying the approval stating the weight control services and obesity treatment are excluded from coverage under the terms of the Member Handbook, but they failed to include the last sentence "unless determined to be Medically Necessary". Should I stick to the point and send them copies of my member handbook stressing the fact that with my BMI of 53.8 I am considered Super Morbid Obese along with several co-morbidites. They also revised a Medical Coverage guideline on 05/15/06 on the Subject of Surgery for Clinically Severe Obesity stating certain surgical procedures performed for the treatment of clinically severe obesity (bmi >35) my be considered medically necessary when all conditions are met, which I do. Do I give them the details of my health again or do I stick to the point restress all of the facts on why the surgery is medically necessary for me? I don't want them to think that I am insuating they are idiots but I also want them to realize that I have done my research as well. Any suggestions would be helpful.
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