Need help writing appeal letter

[Teachingmom 3]

Can anyone guide me what to say in my personal appeal letter to BCBS of AL? My surgeon & gen. Practitioner are writing theirs. But my surgeons bariatric coordinator told me to write one too. I just want to know if anyone else has done This and what kind of info did you include? Is there anything I "don't" need to say? Any tricks or hints to help my plea? I appreciate all you fellow WLS friends!

[Arts137 1,811]

Focus on your weightloss story. Focus on what you have tried to do to lose weight. Explain how your obesity effects your daily activities. Just make it heartfelt.

[ribearty 544]

Teaching mom,

There are some sample letters on the forum. You might want to search for some of them. I agree with Arts, focus on your weight loss and how it interferes with your quality of life. Some have mentioned including photographs as well so they see that you are a person and not just a claim number. It makes it more personalized.

Good luck. .

[bigbeauty78 27]

Can anyone guide me what to say in my personal appeal letter to BCBS of AL? My surgeon & gen. Practitioner are writing theirs. But my surgeons bariatric coordinator told me to write one too. I just want to know if anyone else has done This and what kind of info did you include? Is there anything I "don't" need to say? Any tricks or hints to help my plea? I appreciate all you fellow WLS friends!

Do you mind me asking why you got denied?

[Juciilyps:) 67]

Its a company that helps u with ur appeal ..i can't think of the name i googled weight lose lawyers .

[Teachingmom 3]

Do you mind me asking why you got denied?

Because I had lap band surgery in 2008. I had great success & loved it. But unfortunately. In feb of this year the crazy thing decided to erode into my stomach & make a hole! So I had to have emergency surgery to have it removed. My surgeon suggested the sleeve & I totally agreed. But I had to let my stomach "heal" for about 3 months (minimum). When we tried to submit for approval BCBS denied because of " 1 weight loss surgery per lifetime." But my surgeon is going to try to appeal based on the fact that the band failed me- not vice versa. Very very frustrating & depressing!

[bigbeauty78 27]

Thanks!!

[bigbeauty78 27]

Good luck to you.

[ribearty 544]

Because I had lap band surgery in 2008. I had great success & loved it. But unfortunately. In feb of this year the crazy thing decided to erode into my stomach & make a hole! So I had to have emergency surgery to have it removed. My surgeon suggested the sleeve & I totally agreed. But I had to let my stomach "heal" for about 3 months (minimum). When we tried to submit for approval BCBS denied because of " 1 weight loss surgery per lifetime." But my surgeon is going to try to appeal based on the fact that the band failed me- not vice versa. Very very frustrating & depressing!

Usually the ins. co. will eventually approve sometimes it takes an appeal or two especially in your case where it is a device failure. Here is one link http://wlsappeals.com/ and Ihttp://www.obesityaction.org/educational-resources/resource-articles-2/weight-loss-surgery/insurance-obstacles-for-weight-loss-surgery-patients

My ins. co. has a one wls but will approve another surgery if it is a device failure. My first surgery was not through my employer so my sleeve counts as my first surgery with them even though each will be covered by United Health Care. Makes you wonder sometimes how they determine coverage.

Good luck.

[Bellanthin 112]

Can anyone guide me what to say in my personal appeal letter to BCBS of AL? My surgeon & gen. Practitioner are writing theirs. But my surgeons bariatric coordinator told me to write one too. I just want to know if anyone else has done This and what kind of info did you include? Is there anything I "don't" need to say? Any tricks or hints to help my plea? I appreciate all you fellow WLS friends!

tell them your family history, your history ,tell them if your not happy w your decision you r going to the insurance commissioner, news ,and your lawyer tell them ,why you feel you need it ,have surgeon write why its medically nessasary ,and tell them you dont feel they need anymore proof cause thier desision was base already on paperwork recommended.... that worked for me don't give up thats what they want u too do.. fighters win...also get all paper work from your surgeon....the more u send the better one thing they dont want is u to talk about that on the news....bad businees for them noone will want thier insurance

[Teachingmom 3]

Thanks to all of y'all's advice. I'm hoping & praying this works! So glad this forum exists!

[asauv 6]

you can go onto bcbs website and look at what determines medical necessity for certain procedures. Aetna too. research their guideline and copy/ paste in your letter. i am an insurance nurse. believe it or not, if you can mention ways it will save them money in the future too, that will help. if u are adiabetic you can mention that insurance pays so much a year for insulin but if u loose this weight, it will save them money in the future. i would not mention a lawyer because it has no affect on their decision. physicians and nurses with a license to uphold make these decisions based on medical necessity but if written in plan that it's not covered, that's really hard to get denial overturned. Good Luck!