Appeal Letter

[kerri76 0]

I was denied by my insurance company and plan on appealing the denial. Does anyone have a copy of the letter they submitted for the appeal? Any suggestions for the appeal? Any help would be greatly appreciated.

[cjett 0]

Out of curiosity what is your insurance company?

[kerri76 0]

Blue Cross Blue Shield through the plumbers union.

[sweetsagi 28]

Hi Kerri76

I was also denied and plan on appealing. I found this letter that one of the members posted. I plan on using it myself. Hope it helps. good luck!

Dear (insurance Provider contact),

I am appealing your decision for denying my medically needed weight-loss surgery. My ht and wt are __ and __ and my BMI is __. As statistics show and as medical doctors, you must be aware that diet and exercise help, but as a long term resolution to permanent wt-loss only 5% of people succeed. I am well aware of the risks with this surgery, but I believe the risks of being morbidly obesity out weigh the risks of surgery.

I am _ years old and have been over-wt since I was _ years old. I have been on diets my whole life, having some success, but would always gain the wt back I lost, plus more. I will list the diets I have been on, but never kept any documentation because I could not have known at the time the insurance company would require it. Nor did I know that until this fairly new surgery even became an option for me, I would have to document wt loss before getting the surgery.

(list ALL diets, wt- loss products, programs used. If possible, use documentation.)

I have many co-morbid diseases, such as ___. (list meds also). You can also list family history related to obesity here.)

(discuss everything about how morbid obesity affects your life)

Sincerely, (your name)

__________________

[arends1 0]

Hi kerri76,

I am going through the same as you I have been denied twice. And now am starting the appeal process. If you go to www.lapband.com and search appeal letter they have a really good one also. I also like the one below from sweetsagi. I have bcbs of iowa. Did they say what the reasoning was on your denial? Mine was part of the 3 years I was pregnant and the right before my BMI was 38. I now have BMI of 45 and have hypertenion and high cholesterol.

Let me know how it goes.