Question:
How do you go about fighting your insurance carrier over denial

   — Bruce A. (posted on October 16, 2002)

October 15, 2002
You need to find out what your insurance company's appeal process is and start from there :) Let me know if you need example appeal letters -- I had to write 3 of them to finally get approved :)
   — lilmskitty

October 16, 2002
As Kirstin stated, find out their appeals process. I work for an insurance company and we strictly enforse this policy. The first appeal letter is reviewed by the Utilization Management team (nurses). They look at the plan design to determine, first of all, is this a procedure which is specifically excluded. In which case, is hard to fight. If it's a covered procedure, they then look at the coverage for the procedure (specific requirements, ex BMI of 40 & 100 lbs over ideal). They look to see if you meet the requirements. If yes, you are in luck. If no, then they look at the information you attached with your appeal. some companies are more strict than others. Some will not go outside the guidelines for anything/anyone. when you submit your appeal, be sure to include any/all past dieting, even if you were only on it a day! Include all comorbidities. Include letters of recommendation from all of your physicians. If you have back problems and have had a MRI/CTSCAN, include the results. Include *anything* that shows medical problems. In your letter, explain to them why this surgery will work for you. You may have to appeal several times. Luckily I have not had to do this yet, however, I have a feeling I will. (my insurance is different than the company I work for). Good Luck to you!
   — roryleigh