Question:
Please help me...I need advice for my appeal...

I am meeting with the appeals committee of Kaiser Mid-Atlantic this Thursday. Can anyone help me with supportive documents or anything that would be a benefit or improve my chances? I plan to take another copy of my appeal letter packet including letters of medical necessity, appeal letter, and studies by NIH, American Heart Association and ASBS. They already have these and the lady told me that they will have already reviewed my info. Can anybody give me any new suggestions?    — Morna B. (posted on December 14, 2002)

December 14, 2002
I just went through this with my HMO. Make sure you have all your criteria that is required for your insurance. Positive findings from any lab tests, x-ray reports, as much of your history that you can provide. Documentation if you have seen a bariatric surgeon. Any letters of support from physicians. I would pull out all stops as this is your life we are talking about.
   — Deborah F.

December 14, 2002
Bury them with well organized pertinent medical records, tests, letters between doctors etc. Try to create a summary of your life of being overweight and what you have tried and how long and the results. I realize all of this is likely in the surgeon's letter but if they see you making the effort to organize this so they have a better understanding, it certainly won't hurt your case.<p>List every possible type of co-morbidity you have, even if mild. Get to the heart of it - how will this surgery allow you to improve your life and what does it mean to you. It's ok to be emotional as long as it doesn't get out of hand. You are literally fighting for your life.<p>If your benefits booklet clearly does not say that treatment is excluded for morbid obesity then point that out and the fact that you meet all of the nationally accepted medical requirments. Go in there with your head held high!<p>I have won a long claim appeal battle with BC/BS on chiropractic claims and know the process. Having everything organized and easy for them to know what I wanted them to take from each office note I included and then the long term summary I gave them the day of my appeal was the trick. The bottom line is the chiro did a horrible job of documenting the need for treatment, so I had to put together the total medical picture at the time and why no other options were available to me at that point. They commented on how well organized the information was and I am convinced that had a lot to do with me winning. Good Luck! Chris
   — zoedogcbr

December 14, 2002
Are you on any medications for co-morbid conditions which might improve or disappear with surgery? On any treatment for sleep apnea? If so, you might point out how much these treatments cost, and the likelihood statistically of your being able to cease them after surgery. You could also mention the long-term complications of any comorbidities, as well. Your having surgery might, in the long run, save *them* money.
   — Susan A.