Please read my appeal letter & critique

[honeyrubybee 1]

I know I probably should have posted this in another topic area but I figured I get more input here. Thanks y'all!

To Whom It May Concern,

I am hereby requesting a reversal of the initial denial for the bariatric surgery(WLS) known as the Vertical Sleeve Gastrectomy/Gastric Sleeve (VSG) by BlueCross BlueShield of Illinois. This request is made due to BCBS's assessment that my BMI is below 40. At my initial consult with Dr. Rantis, my BMI was 40.5. At that time, I met your requirement of a BMI greater than 40 without comorbitities. BCBS required that I follow a 3 month, medically supervised diet. In doing so, I lost weight and therefore, my BMI lowered slightly. To deny me for WLS because I followed BCBS requirements is profoundly confusing to me, not to mention unfair and devastating. I HAVE met the medical requirements to establish medical necessity for VSG.

I am a 35 year old, morbidly obese female. I have been overweight or obese for my entire life, childhood through adulthood (my medical records prove this). While, I currently do not suffer from any comorbitties, it is just a matter of time until I develop the many disease that run in my family. Type II diabetes, hypertension, high cholesterol, arthritis and Cancer are diseases that are in my bloodline. It is not "if" I develop these horrific diseases but "when" will I develop these diseases. At my current state, I am a ticking time bomb. I have tried countless times throughout my life to lose the weight and keep it off. I can manage to lose a little bit of the weight but always gain it back and then some. Again, my medical records prove this. I have 3 young daughters and I need to be healthy and live a long time for them. I am confident that the VSG is the tool I need that will save me from the misery that obesity always causes.

This surgery will open a new door in my life. I will no longer feel ashamed of my body and my health. I will no longer have to worry about the impending diseases I will most certainly face. I will not have to worry about about my children having to watch their mother suffer because of obesity. The surgery will allow me to live the life I have always wanted and deserved. I am asking for you to reconsider your denial and approve coverage of the VSG.

Please take a closer look at my request and approve for the VSG. You will see that I have met the requirement of a BMI greater than 40 and successfully completed the 3 month medically supervised diet. Thank you.

[TijuanaPlication 87]

Not a criticism I'm afraid, but it's well written (grammar, no typos, etc) and to the point. I hope it works and that you maybe get something a bit more constructive from someone else.

[Oopsseedaisy 90]

Please take a closer look at my request and approve me for the VSG. You will see that I have met the requirement of a BMI greater than 40 and successfully completed the 3 month medically supervised diet. Thank you.

I am not the best editor, but I thought the me should be added.

[Was a humpty dumpty 35]

I know I probably should have posted this in another topic area but I figured I get more input here. Thanks y'all!

To Whom It May Concern,

I am hereby requesting a reversal of the initial denial for the bariatric surgery(WLS) known as the Vertical Sleeve Gastrectomy/Gastric Sleeve (VSG) by BlueCross BlueShield of Illinois. This request is made due to BCBS's assessment that my BMI is below 40. At my initial consult with Dr. Rantis, my BMI was 40.5. At that time, I met your requirement of a BMI greater than 40 without comorbitities. BCBS required that I follow a 3 month, medically supervised diet. In doing so, I lost weight and therefore, my BMI lowered slightly. To deny me for WLS because I followed BCBS requirements is profoundly confusing to me, not to mention unfair and devastating. I HAVE met the medical requirements to establish medical necessity for VSG.

I am a 35 year old, morbidly obese female. I have been overweight or obese for my entire life, childhood through adulthood (my medical records prove this). While, I currently do not suffer from any comorbitties, it is just a matter of time until I develop the many disease that run in my family. Type II diabetes, hypertension, high cholesterol, arthritis and Cancer are diseases that are in my bloodline. It is not "if" I develop these horrific diseases but "when" will I develop these diseases. At my current state, I am a ticking time bomb. I have tried countless times throughout my life to lose the weight and keep it off. I can manage to lose a little bit of the weight but always gain it back and then some. Again, my medical records prove this. I have 3 young daughters and I need to be healthy and live a long time for them. I am confident that the VSG is the tool I need that will save me from the misery that obesity always causes.

This surgery will open a new door in my life. I will no longer feel ashamed of my body and my health. I will no longer have to worry about the impending diseases I will most certainly face. I will not have to worry about about my children having to watch their mother suffer because of obesity. The surgery will allow me to live the life I have always wanted and deserved. I am asking for you to reconsider your denial and approve coverage of the VSG.

(Remove >Please take a closer look at my request and approve for the VSG). Sounds too nice , add below>>

You will see that I have met the requirement of a BMI greater than 40 and successfully completed the 3 month medically supervised diet. Thank you.

ADD

This is a formal request to file a grievance through BlueCross BlueShield of Illinois for Bariatric surgery which is being unfairly

denied by BlueCross BlueShield . Attached find the BlueCross BlueShield of Illinois grievance form (Look on the Blue shield website for the form)

form regarding a recommended bariatric surgery by my doctor, Dr. ____. He believes bariatric surgery would significantly benefitmy health.

I am filing this as a “last resort” before filing a formal complaint with the Illinois Comprehensive Health Insurance Plan.

This appears to be a classic case for an Independent Medical Review through the ICHIP.

I would like to resolve this matter short of having to file a complaint with this government agency.

This is their web site.

http://www.chip.state.il.us/grievance_procedure.htm

Good luck,

Jackie

[honeyrubybee 1]

thanks, ladies! cross your fingers for me!