Question:
Need an excellent appeal letter from someone who appealed an exclusion

A friend has a pretty tough exclusion written into her policy. It says, more or less, "We will not pay for any surgical expenses, supplies, hospital confinement, etc. for treatment of morbid obesity. WE already know about ObesityLaw.com, but would like to try a DYNAMITE personal appeal letter first, which would accompany the one her surgeon is going to send. Has anyone ever successfully appealed such a strong exclusion? If so, we'd greatly appreciate a copy of your letter. Thanks.    — Donna S. (posted on May 23, 2000)

May 23, 2000
I found a great example letter at clos.net that helped me. I too was denied the first time. This example gives reasons on exclusion and medical necessary. Hope this helps and best of luck.
   — Donna A.

May 23, 2000
Although I don't have a sample letter, I would ask them to justify the exclusion under the Americans with Disabilities Act. In order to maintain a disability based exclusion (and they have worded this one in such a way that it specifically mentions morbid obesity), there are certain criteria that they must meet. For example, covering the condition would cause the cost of the policy to rise to where no one could afford it. I'm not an attorney but if you read the full text of the ADA you can see that the reasons are there. Unfortunately, many insurance companies try to avoid the issue and won't answer the question
   — Joyce L.