Question:
Need help with first letter to insurance company

I need some help writing a letter to my insurance company, I am going to be submitting my claim on july 1 st. I want to be approved so bad (just like everyone else, I know)..... I want my letter to point out the risks of not having this surgery. and to show that my life would be much better if I had this surgery. You can find my info on Dr. Waltons patient forum. PLEASE would you share your letters with me. [email protected] is my email. I am desperate for help.    — B D. (posted on June 20, 2003)

June 20, 2003
Hi, I just wanted to say that I never submitted my own letter to the insurance, even though I wanted to because I felt it would help strengthen my case. A co-worker who had the surgery a couple years ago advised me not to, to just give them what they asked for. I took her advise, and when it was requested that I have a psych evaluation to determine motivation and compliance because my "comorbidities appear to be mild," I was able to explain to the psychologist all the stuff I wanted to put in my letter, stuff like having to use a wheelchair when I go to the store, like waking up EVERY day in pain either from my feet, knees, back, or all of them hurting; like the pain getting worse and worse as time goes on... After my psych evaluation, I was approved less than a week later. Those are all things I wanted to put in my letter, but I was able to express them to the psychologist and he put it all in his report. Good Luck on getting approval, and God Bless...
   — Moysa B.

June 20, 2003
B, before you go writing letters to the insurance company, find out what criteria they use to approve the surgery, IF it is a covered benefit. Sometimes writing a letter is pretty much a waste of time, and the insurance company doesn't really care how much you need the surgery and how great your life will be after you have it UNLESS you meet their criteria! Sometimes it can even backfire on you, so don't send in any letters until you find that you need to. Also, your surgeon is the one who will be seeking approval for the surgery, and it will be that person's responsibility to send the information. I just don't believe the insurance company will look at your letter and give you an approval without something from the surgeon. It sounds like you are ready and enthusiastic about the surgery, but slow down and let the process move as it should at this point. You might need the info in the letter you want to send for an appeal later on, so hold off for now.
   — koogy

June 20, 2003
There is a lot of good information on this website for you to utilize. There is a sample letter here that may help you. Go to the top of this page and click "Your Journey", when you get to the next page look at the links on the left andn scroll down to "Getting Authorization" and click that, then when the next page populates look at the links on the left scroll down to the white box that says, "Letter of Medical Neccessity" and Voila!! Hope it helps.
   — ToriJ

June 20, 2003
I forgot to mention one thing. After you click on my journey(at the top of this page) the very next page you get you need go to the link that says "Preparing for your Initial Consultation" click that and then follow the other steps I mentioned. Sorry about that!
   — ToriJ

June 20, 2003
Hi! I have my complete letter in my profile. It is very through and detailed, and literally hundreds of people have used it and gotten approved the first time around. I haven't heard of anyone that has been denied. All you need to do is personalize it to your situation, and send it off! :~) If I can help you, email me. I am more than willing to help any other AMOS member! :~)
   — Sharon H.