Appeal-please Read/help!!!!!!!

[KayKay 0]

I have just been denied lap band surgery for what ever reason.I am so depressed at this point and jsut thinking about giving up. :thumbup: Could someone PLEASE help me with information in regards to an appeal????? Any suggestions?

[Wheetsin 714]

First suggestion - find out the reason. If your insurance company didn't include a reason in the declination, then call them and get it. They have to provide it to you.

You'll need to know why you were denied in order to know what to do going forward.

[losing it in ne 0]

I'm not sure why you were denied but don't give up. A wedsite call obesityaction.org has a lot of info on insurance and appeals things you may not have thought of. Check it out and keep going.

[KayKay 0]

I have BC of TN-They stated that evidence did not support and they did not feel like it was medically necessay. However my BMI is 39.6 and I have co mor. problems and have been able to supply medical documentation that I have been obese for the past five years.

[Wheetsin 714]

What are their requirements for approval? "Evidence did not support" and "don't feel it's medically necessary" aren't valid reasons for declining a claim.

They can't "feel" anything, feelings has nothing to do with insurance. Either requirements were met or they were not. Would you feel comfortablt typing exactly what your letter says?

[KayKay 0]

I just found it. It states that Based on the information recieved and the terms of your health benifit plan, we determined that the requested service is not Medically Necessary.

However my doctor states that it is necessary for my health.- He stated before and is putting in writing to send to BC of TN.

Any suggestions, I am so tired of being over weight!!!!!!!!!!!!!!!!1

[Wheetsin 714]

Then call and ask them what their definition of "medically necessary" is. Again, this is info they have to give you. It may often include things like a letter from the surgeon, BMI requirements, weight history, etc. BUT if these aren't things they require, submitting them won't do anything toward approval. You need to make them itemize the requirements for you.

Insurance battles can be tough, we are our best advocates and cannot afford to take the job lightly.

[wendy645 1]

I don't have much to offer besides my support. I was denied, too, so I'll be keeping an eye on this thread. Best of luck!!!