Question:
I am approved for 4,000.00. I need more money for the surgery. How do I appeal.

I have been approved for 4,000.00. Initially for the surgery. However we all know that 4,000.00 is not enough for the surgery. I can go to my insurance co and ask that they raise the limit to help pay more for the surgery. I can list my co-morbidities, and I can get my PCP to do the same. At this point I am so emotionally frustrated with this whole game of insurance, dr's, hospitals, pre-tests, and paperwork, I am exaused beyone what I can really do. I need a break, but as we all know can never let up even for a moment or somewhere the ball might get dropped and then we would have to get started all over again. So, this weekend I am starting to write this letter of appeal. If anyone has any good previously written letters, that I could cut and paste. Please email me. I could use the help. Thanks Rachel    — Rachel D. (posted on February 25, 2003)

February 25, 2003
Rachel, Most improtant is to realize this is a journey. Try not to be emotionally frustrated try to shift that to emotionally resolved that no matter what you are going to have that insurance company pay for it all. My journey to surgery was three years long, for other reasons. There is somewhere on this website or the www.WLS.com website that they do support you in how to appeal. Good luck!!
   — Rachel R.

February 25, 2003
I've never heard of this, an approved amount for a surgery? How strange! I think your best bet would be to contact Walter Lindstrom (a wls patient himself, attorney) When you deal with appeals you don't want to waste them as they are your last resort. Best of Luck!
   — ZZ S.

February 25, 2003
I've never heard of this, an approved amount for a surgery? How strange! I think your best bet would be to contact Walter Lindstrom (a wls patient himself, attorney) When you deal with appeals you don't want to waste them as they are your last resort. Best of Luck!
   — ZZ S.

February 26, 2003
Is it only 4,000.00 because your using an out of network pcp? Just wondering, my insurance co would of only paid like 60% if i used an out of network surgeon. My hospital bill came to 28,000.00 and my insurance talked the hospital down to 9,000.00 so now they paid 8,000 and i have to pay 1000.00. Weird huh, you would think they would just pay it all since i only have a 400.00 family deductable. Anyway, I would find out about if its because your using an out of network surgeon or what. You can find out if your using someone in network by looking under general surgeons. I found out thats what mine is listed under because they dont have a bariatrics section in my insurance booklet. Anyway, what it all would of costed me was 1600.00 for the anestiaologist, 3500.00 for my surgeon, and 28,000.00 for my hospital room, also, that doesnt include before surgery costs of preadmission testing wich was 800.00. I was lucky cause my doctor said that what ever the insurance pays is what he will get paid, no extra expenses to me. You might want to call your insurance co and see what they will pay for, if thats only the surgeons fee they are saying or if it includes the hospital and everything, i dont see how they can not pay your hospital bill and other stuff needed. Good luck.
   — rachel W.