Question:
Can you guys tell me what you think of this appeal letter?

   — Kim W. (posted on April 29, 2003)

April 29, 2003
I think the letter is great but I do think that you should put your comorbids at the beginning of the letter right after which diet plans you have been on. This might catch the attention of the person reading it right away. Good Luck!! I don't think that I could of written a better one.
   — jenniemminor

April 29, 2003
I think it's a lovely letter. Your friend is very articulate. Personally I'd keep the letter exactly as it is but I'd attach another page of comorbid conditions just listed one after the other so it will be easier for the reviewers if they have to discuss it in a group. The letter is very touching and I'll say a prayer for your friend. She's lucky to have a friend like you too. Best wishes!
   — ronascott

April 29, 2003
Just a comment -- 60 years of age is not the upper limit for WLS. I had mine at 67 (in 02) and others have been older. Of course, there are doctors who refuse to consider anyone over sixty but there are plenty of others who will take on us elders. Nina in Maine
   — [Deactivated Member]

April 29, 2003
Well, I think it is a wonderfully worded letter. There is one very minor detail that I would change. I would not address the letter to "gentlemen". That is the old-fashioned way of doing this. I believe there are many women reviewing appeals and I wouldn't want to offend from the beginning. She may not concentrate on the rest of your letter, if right at the start you alienated her. I am not sure of the exact and proper wording, maybe someone with more experience can help. To Whom it May Concern, doesn't sound too bad to me. Shelley
   — Shelley.

April 29, 2003
I think this letter is very good in most respects, especially in listing the obesity-related problems and how these will cost the insurance company more money. I do have a major concern, however. It says early on in the letter that the request was denied "because I had no documented proof from a doctor that I had been on a diet plan". The applicant then goes on to say that she had never even considered seeing a doctor for her obesity. This is a big problem! The insurance companies want to know that the MO person has tried all avenues, ESPECIALLY medically-supervised ones. To say that a person hasn't ever considered getting the input of a physician for weight-loss doesn't show the insurance company that the patient has been educated or supervised from a medical standpoint on proper nutrition, weight loss, or obesity. I don't think that the insurance company will budge on this one, as they're pretty strict about that. It IS encouraging that the patient's PCP is supportive; perhaps the insurance company would be receptive to a detailed letter from the PCP stating the patient's history, discussions between the PCP and the patient of her weight-loss attempts and plans, etc., so that the insurer can see that even if there wasn't an "official" medically supervised diet, the doctor WAS aware of, approved of, and was monitoring the patient's weight loss efforts. Without this documentation from the doctor (and maybe even regardless of this type of letter), the patient will probably be required to undergo a physician prescribed, monitored, and supervised diet plan, usually for at least six months. Actually, it may take less time for your friend to do that in the first place - and get that necessary aspect of the insurance requirements - than to fight it. Other than that (I think very significant) sticking point, this is an excellent letter and argues the case very well.
   — johanniter

May 1, 2003
Is your Dr/PCP willing to write a letter on your behalf stating you tried many diets while under his/her care? ... It is sort of a tricky way of wording it. He/she may have not actually gave or supervised your diets but was aware you were on them and the end results.
   — Sarah H.

May 1, 2003
If the only reason your friend was denied was due to a lack of a supervised diet, her best bet is to get to a doctor as soon as she can and get put on a 'diet'. Many insurance companies only want 6 months of supervised diet attempts. If she goes to the doctor now, she can have that done in no more time than it would take to get an appeal submited, reviewed, etc. It sounds like her insurance does cover the surgery if she meets the conditions, so she should do her best to meet those conditions. If they want several years of supervised diet attempts, that's another thing altogether. But most of what I've seen on here suggests that insurance wants 6 months to a year at most, of such attempts.<p>The one other thing I advise about this particular letter is to drop the information about the embarrassment, etc. While we all understand what that is like, it's not likely to make the company change its mind. The facts about her co-morbidities, how they are costing the insurance company now and will only get worse in the future, thus costing them even more, are what they're more likely to pay attention to. There's a good article in the current Reader's Digest about appealing insurance denials in general. That would be a good one for her to read.
   — garw