Example of Appeal Letter (UHC-Choice Plus)

[Cindy_Wisc 3]

Would anyone have an example of an appeal letter that you wrote to your insurance company? My surgeon's office has been fighting with my insurance company and are filing an appeal and they suggested that I write a letter, too, and I'm not sure what I should write in it.

This has been a very frustrating process for me and I think I need to give this my best shot. I am trying to get approval for VSG.

You can e-mail me at cindys32@yahoo.com or leave a document here for me.

Thank you so much!

[greensleeve 457]

I have the same insurance. What is their reason for denial?

[Cindy_Wisc 3]

Various reasons were given. The thing that ticked me off is that I had called to see if I had coverage and I met all the criteria but now that my surgeon submitted the paperwork for the VSG I'm getting all kinds of grief.....

1. They are saying that my co-morbidities are well-controlled with medication so they don't consider them true co-morbidities.

2. They said that my BMI had dropped to 35 a couple of years ago (which was true but I'm now back at BMI of 39).

3. They won't accept blood tests from 2 years ago showing that I was pre-diabetic. Guess I shouldn't have watched my diet like a hawk for a week before my latest blood tests were taken.

4. My surgeon missed the peer-to-peer review window and now UHC is denying the peer-to-peer request which means I am now in an appeal mode. This one ticks me off because this was the responsibility of my surgeon's office and they obviously missed the boat.

5. My surgeon's office neglected to send in my sleep study paperwork and had to do that later which caused some issues, too.

The cards are stacked against me.

[greensleeve 457]

Uhc is a nightmare. I had to appeal twice and every time I called I got a different answer.

Don't give up. It took me two years and I ended up with a third party review and won.

If I were you I would point out that yes you lost weight but obviously you didn't keep it off.

Other option is to try to get your BMI up to 40. How many pounds away are you? I have heard of people putting weights in their clothes, wearing ankle weights, etc.

[Cindy_Wisc 3]

Isn't it too late for weights? The insurance was submitted with my beginning weight back in February.

[Jenn B. 4]

Omg this thread is making me nervous I have UHC choice plus they my husbands company and my surgeons office said they love working with UHC. Easiest approval but according to this UHC has been a nightmare. I'm just starting my journey so now I'm feeling a little paranoid they could deny me.

[LadyPullings 94]

I have UHC as well and it does seen impossible to get answers from them! I am waiting on my authorization to are the surgeon so that I can start my process.

What was your first consult with the surgeon like? What did it consist of?

[Jenn B. 4]

I have my first consultation August 11, so we will see what happens.