Insurance Denied - HELP

Tammy G
on 10/20/05 9:10 pm - Beverly Hills, FL
Please HELP!!! I know this has been asked before but now I need help. My insurance denied me because "not medically necessary". I am 5'11" and 295 lbs, high blood pressure, mitral valve leakage, DJD in my spine. Does anybody have appeal letters as a guide for my appeal? Any and all help would be appreciated. My primary has written a strong letter, I have a psychological I am picking up Monday to also send along with Drs notes from prescription WLS meds in 96 and 99. Unfortunatly, I do not have the proof of Phen Fen because I went to a clinic that is long gone since it was pulled from the market and they filled the script at the clinic weekly so I cannot go to a pharmacy for the receipts. I am just so tired of being sick and tired from being overwight. Also, I had verticle gastric banding 15 years ago and my meal consumption is still pretty limited so that is why RNY is recommended for the malabsorbtion aspect. All my tests upper GI, bloodwork, gallbladder ultrasound, stress test (which I failed and had to have a cardiac cath done), H pylori have been all done and the insurance paid for all of this. PLEASE HELP!!!
hessie28
on 10/28/05 1:59 pm
Hi Tammy, I emailed you. I appealed and won. I'll email you a copy if it will help. I was also excluded due to it not being medically necessary. I was 231 so they felt not big enough. I also did Phen Fen and have valve damage from it. Good luck.
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