Question:
Denied for Surgery need your assistance

Can anyone give me advice on how to proceed, with the appeal process?    — jazzaie (posted on July 10, 2003)

July 9, 2003
Hi Karen, You need to know why you were denied so you know how to appeal the decision. If you go into the AMOS archive and look through the appeals section you will find ALOT of helpful information including sample letters. You may even find people who have had succesful appeals with your insurance company. Best regards,
   — M B.

July 10, 2003
Hi Karen, You didn't say what ins you have, but one thing I can suggest you do is have your pcp write a letter to your ins co. about your weight issue and what all you have tried to do plus how it effects your life and what co-morbities you have. My mom had her pcp write her one plus her surgeon wrote one for her too and that may help out alot! Also, if that doesn't work then have your pcp call your ins co personally and talk to one of the admistrators over the phone who handles the dicision making cuz I heard that it can help alot! Good Luck to you and keep us posted!
   — Melodee S.

July 10, 2003
Hi Karen :) Why were you denied? Was it based on Medical Necessity, or perhaps an exclusion in your plan. It is important to know that before you take the next step.
   — amandalianne

July 10, 2003
Hi Karen, I'm in the exact same situation as you are. (My last supervised diet Dr. appt is Aug 12. Y E A ! ! ) I called Atena's precertification phone line and asked your exact question. I was told that when the 6 months is up, I should contact my surgeron and have his office get the medical records from the Dr. that supervised my weight loss program. (Com[plete medical records are required. A Dr.s summary letter will not work.) His office should then resubmit the original request with this updated information. I asked if I could send a letter also and was told that I should give my letter to my surgeron and he shoud fax it with his request. Hope this helps! TOM
   — Tom Barton