Question:
Appeal letter

I need some tips on writing a good appeal letter. Any information will be helpful. Denied because I am responding to treatment for hypertension and Sleep Apnea And my BMI is 39.9.    — Supersize (posted on September 3, 2009)

September 3, 2009
Everybody is responding to treatment for high blood pressure and sleep apnea and still get accepted for surgery. They should have accepted you for those two co morbidities, as these are life threatening issues. The sleep apnea, as you know you could stop breathing in your sleep. Wow, what a crummy insurance company. Did your doctor and surgeon send the letter to the insurance company deeming it "medically necessary" to have surgery? I have some tips, I will have give them to you later. But make sure your doctor and surgeon are on board with you. Who sent in the letter the first time. Your surgeon should be doing the appeal letter for you. They The Bariatric Surgeon should be sending in all of your information to the insurance company. Give me some more info and I will help you further. I will look for the appeal letter and get back to you.
   — Kristy

September 4, 2009
Hi. Sorry to hear about the troubles with your insurance. I tried back in 2006 and even after an appeal was still denied because the contract my employer signed dicatated what was covered, regardless of medical necessity. My doctor was really surprised that my appeal did not go through since it was so thorough. When submitting your appeal letter, make sure you state how your weight and co-morbidities effect your quality of life. Your constant fear of not waking up one morning due to your apnea. How your ability to travel is restricted/limited due to need to take your c-Pap machine with you. The fatigue and loss of a social life due to your weight. The aches in your feet, knees and lower back when on your feet for a long period of time. Really show them how miserable your life is and how necessary this treatment is. Also show them how many other diets, excerise programs and any other attempts you have made over the years to lose weight, how much you lost and how much you gained back. Details, details, details. This year I was able to come up with the funds to pay personally for my VSG on 8/10 and it was money well spent. Hopefully if your appeal does not go through you can find another alternative.
   — Cynthia W.

September 4, 2009
Try going to the internet site "obesityaction.org". Once you are on the site, look down the left side and click on "advocacy tool" which will give information about insurance and give you tips on how to talk to your insurance representative. You'll need to go through several pages of info. to get to the place where you can "click here" for a sample letter to send to your insurance company if you are appealing a denial. Good luck! KimM
   — KimM