Appeal Letter...

[mstratto 31]

Hi all,

I was originally told by my surgeon's office that the insurance "approved" the band-to-bypass revision, but unfortunately there were some miscommunications on their end and the insurance company actually denied (they are saying that it's not sufficient enough to approve this surgery because the band is still technically in place and hasn't "failed" even though medically it has failed in terms of WL success and more than occasional vomiting). Talk about a roller-coaster - - excitement and hope followed by sadness and dispare... but I want this badly (and NEED it), so I'm about to draft an appeal letter. Do any of you have advice on what I should state in the appeal letter? Any other suggestions? Thanks,

~Micheal

[DLCoggin 1,788]

Many insurance companies require a "letter of medical necessity" from your primary care physician before they will approve bypass surgery. Rather than draft a letter of appeal yourself, you might want to discuss the situation with your PCP and see if he/she would be comfortable with writing the letter. You might also want to discuss with the surgeon that did your band as well. Especially if the surgeon does other bariatric surgeries in addition to the band. Revision from the band to the bypass is relatively common and sometimes covered by insurance. Either one or both letters will likely improve your chances of getting approved. Whatever you do, don't give up. If you're persistent you will prevail!!

[mstratto 31]

thanks so much!

[kparadisek 115]

Any luck with your appeal? I have to have the revision too and hope that my insurance will pay for it.

[mstratto 31]

Yep! Scheduled for Jan 21 surgery date!!!

[kparadisek 115]

Mstratto, congrats that's just around the corner. Keep me posted!