Hints on how to write an appeal letter?

[college_chick 20]

I was denied on April 30th from BCBS Federal because 3 weights out of my 2 year history went below a 40 BMI (the lowest was 38.1) but this was because I was on phentermine at the time. My parents insisted that they help me write this denial letter (my mom works with insurance companies for a living) and I'm grateful for their help but it is going on a month and a half and I'm still twiddling my thumbs waiting for them to help me. My insurance runs out in January so I don't have a whole lot of time to get this surgery done because I have to fit it in during breaks from school.

Does anyone have any tips on how to write this appeal letter? I feel like if I don't do this myself it will never get finished. Thanks

[DeniseM 238]

I have worked in the medical field for 20 years, and typically when an insurance company denies a procedure for medical necessity, such as they did with you, the only thing that I have seen success with is for the surgeon to write the appeal letter giving his medical opinion on why the surgery is medically necessary. Have you talked to your surgeon's office and asked them for help? Now, this could be different for bariatric procedures, but in my experience, patient appeal letters do not work as well as physician appeal letters.

[Atlgadgetgrrl 6]

check your denial letter for the amount of time you have to provide a response. I know with my two denials, there were specific dates mentioned in the letters that the response had to be received by. I can't remember if it was 30 or 60 days.

Good luck to you -