Need to submit an appeal.....any suggestions? Special info. To include in the letter. Does anyone have a letter I could read to get ideas?

[Teachingmom 3]

I got the first initial denial And now we have to submit an appeal letter. I know all the obvious info. To include plus all the doctors notes on his end. But is there anything else I need to include that'll boost my case? It's a cut & dried case to me but apparently BCBS doesn't think so. I am trying to get the sleeve since my band was removed in February in emergency surgery due to erosion and a hole in my stomach. I loved the band- it totally worked for me! But my surgeon doesn't even put them in anymore. So he suggested the sleeve. I'd appreciate any suggestions, comments, secret tricks! Thank you in advance for even reading my posts- I LOVE getting "real people" advice from people who truly understand!

[thinathart 197]

What was their reason for the denial?

[Teachingmom 3]

What was their reason for the denial?

Well, to TRY to make a long story short I had the lap band put in with blue cross of al with another company. Now I have blue cross through the school system. They said only 1 WLS per lifetime. But they do have an exclusion for that if the failure was not due to the patient not following the "rules." I loved the band & had total success with it. It was the band that broke down & eroded. I was down to about 150 lbs., no diabetes. Now I'm back up to about 205 with a BMI of 35.2. And I'm back on metformin for high blood sugar again! So my surgeon is totally on board for doing the sleeve as soon as insurance cooperates. But now we have to appeal it. My surgeons coordinator said she'd do whatever they need to on their end.