Denied.................

[Rekeca 0]

So I got the letter from my insurance(AETNA) yesterday stating that I was denied. I was a little disappointed but surprisingly not upset. I felt like the denial was just a road block because I am destined to have this surgery. I was denied because they stated that I wasn't obese for the last two years. It just so happens that last year I lost about 40 pounds which put me under the 35BMI with two comorbities. I kind of figured that, but I hope that they would have seen that I promptly gained it all back and then some. (I guess not). I have been overweight for the longest time. Since back in high school and problem even middle school, I just chose to try to lose weight at the wrong time. My question is has anyone had this issue, appealed your insurance and won? Are their any good appeal letters out their? I am determined to get this surgery. I have jumped through all of the hoops they have required and paid ump teen dollars for all the testing and office visits that they require, so I am not going out with out a fight. Any suggestions anyone.

[Day Dreamer 23]

So I got the letter from my insurance(AETNA) yesterday stating that I was denied. I was a little disappointed but surprisingly not upset. I felt like the denial was just a road block because I am destined to have this surgery. I was denied because they stated that I wasn't obese for the last two years. It just so happens that last year I lost about 40 pounds which put me under the 35BMI with two comorbities. I kind of figured that, but I hope that they would have seen that I promptly gained it all back and then some. (I guess not). I have been overweight for the longest time. Since back in high school and problem even middle school, I just chose to try to lose weight at the wrong time. My question is has anyone had this issue, appealed your insurance and won? Are their any good appeal letters out their? I am determined to get this surgery. I have jumped through all of the hoops they have required and paid ump teen dollars for all the testing and office visits that they require, so I am not going out with out a fight. Any suggestions anyone.

Hi Rekeca,

I have been where you are. I was denied by TriCare and Kaiser because I so too low BMI and didn't have history of BMI (Kaiser). I think you should definitely proceed with the appeal letter. And if all else fails, you can self pay (pricey, I know).

Please check SleeveGenie's blog about her appeal letter:

http://www.verticals...health-care-ca/

Good Luck !!!!

[wishes 125]

I am so sorry, but your attitude about this is just amazing. I am so glad you are not going to give up and keep pushing because it is what is right for you. Good luck on writing your appeal letter.

[Rekeca 0]

Thanks for the pat on the back and thanks Junior Guru for the blog on appeals