Question:
I NEED SUGESTIONS IN COMPOSING MY PERSONAL APPEAL LETTER TO INSURANCE COMPANY?

DOES ANYONE HAVE A SAMPLE LETTER I CAN GO BY?    — Nicole H. (posted on June 17, 2002)

June 17, 2002
Here are a few of my suggestions: Include in the letter the diets you've been on and lenght of time. Include the costs involved in these diets (Jenny Craig, etc.). Tell them about your health; blood pressure, cholestoral and any other problems you have. Also have your doctor write them a letter. Ask your PCP and weight loss doctor to give you the letter so you can include it in yours. Also, you may want to ask your employer to give you the name of their contact person at your insurance company and deal directly with that person. If you write a "blind" letter, sometimes it gets bounced around from person to person and no one gets the information. Include in your letter your height, weight, etc. Include information regarding the surgery and what your long term goals will be. Good Luck!
   — dolphins94

June 17, 2002
Nicole, I just e-mailed you a copy of my letter to CIGNA and my personal diet history. However, I forgot to tell you what I was doing. I got so caught up in the cutting and pasting from my Word file I forgot to tell you who I was. Sorry for the confusion! I truly did mean well. Mary
   — MARY W.

June 17, 2002
Here is a letter I found on the internet that I plan to use, I just changed some of the things in it to fit my condition. Good Luck!! To whom it may concern: I was referred for this surgery by my PCP, who is very concerned about my health because of severe morbid obesity. I am a 31 year old morbidly obese female who is 5'5 " tall and weigh 245 lbs., giving me a body mass index of 42. The body mass index is calculated by dividing a person's weight in kilograms by their height in meters squared. When a man's BMI is over 27.8, or woman's exceeds 27.3, that person is considered obese. The degree of obesity associated with a particular BMI ranges from mild obesity at a BMI near 27, moderate obesity at a BMI between 27 - 30, severe obesity at 30 - 35, to very severe obesity for patients with a BMI of 40 or greater 1,2,3. Therefore, I may be classified as being very severely obese. The annual number of deaths in America attributable to obesity has been estimated to be 300,000 deaths per year. With my abnormally high BMI, I am at an estimated 90 percent increased risk of death at my present weight. I also have an extremely strong family history of comorbidities my mother that just turned 64 underwent surgery for total knee replacement in august of 2001 and plans to have the other knee replaced in the near future. My father at age 50 had a heart attack and and age 60 died from complications due to dieabeties some of which include, loss of eyesight, loss of use of his kidneys(was on dialysis 3 days per week), amputaion of leg from the knee down. Both of them obese. My mother is also a diabetic and has high blood pressure. I the statistics show that by both my parents having these problems that it is just a matter of time for me. I am having significant adverse symptoms from my obesity. I have difficulty standing. I have difficulty performing my daily activities, and in participating with my family in recreational activities. I have arthritis and pain of my weight-bearing joints.. An increase in body weight adds trauma to weight bearing joints and excess body weight is a major predictor of osteoarthritis of the knees. This is a mechanical problem and not a metabolic one. Weight loss will markedly decrease the chance of developing osteoarthritis. I also suffer from shortness of breath. There are several abnormalities in pulmonary function in obese individuals. At one extreme are patients with so-called Pickwickian syndrome, or the obesity-hypoventilation syndrome, which is characterized by somnolence and hypoventilation; it eventually leads to cor pulmonale. In patients who are less obese, there is a fairly uniform decrease in expiratory reserve volume and a tendency to reduction in all lung volumes. A low maximum rate of voluntary ventilation and venous admixture is also present. As an individual becomes more obese, the muscular work required for ventilation increases. In addition, respiratory muscles may not function normally in obese individuals. Because of my pains and aches in my back and legs I have difficulty sleeping, and therefore, am fatigued and tired during the day. This surgery usually helps with sleep disturbances. I have made many, many attempts to lose weight and this has gone on all my life. I was put on medications by my doctor to help lose weight. I would lose some weight then gain it all back, and more. I have also tried many exercise programs. I have tried Richard Simmons, Metabolife, Atkins, 1200 calorie diets, slim fast, and several other products. My physician put me on Meridia, but after taking this product for about a month I was doing some research on it and studies say it can be addictive, so I discontinued use. As you can see, I have spent all my adult life trying to lose weight. I am now at the very edge of complete disability and am at a point where everything is an effort. The obese individual has functional impairment in the activities of daily living. This disfunction impacts sleep, recreation, work and social interactions. Economic costs of Obesity: Obesity has been shown to directly increase health care costs. In an article in the March 9, 1998, issue of the Archives of Internal Medicine 17,118 members of the Kaiser Permenente Medical Care Program were studied to determine the association between body fatness and health care costs. The results showed that patients with BMIs greater than 30 had a 2.4 times greater risk for increased inpatient and outpatient costs than patients with BMIs under 30. Indirect costs: Americans spend an additional $33 billion dollars annually on weight-reduction products and services, including diet foods, products, and programs. Most of these expenditures, as is evidenced in this case, are not effective. Rather it can expected that he will continue to gain weight and the costs of co-morbid conditions, including the ones he already has and ones he surely will acquire as time goes on, will far outweigh the costs of gastric bypass surgery that we are asking you to please approve for this gentleman. As you can see I have exhausted all the traditional ways to lose weight. The gastric bypass is an approved and proven means to permanently lose weight. Please approve this surgery for me. Thank you. Sincerely, Donna J. Rutherford Reference Sources: 1. Weighing the Options: Criteria for Evaluating Weight-Management Programs. Institute of Medicine, National Academy of Sciences. 1995; 50-51. 2. Kuczmarski, R.J., Johnson, C.L., Flegal, K.M., Campbell, S.M. Increasing prevalence of overweight among US adults. Journal of the American Medical Association. 1994; 272:205-211. 3. Troiano, R.P., Kuczmarski, R.J., Johnson, C.L., Flegal, K.M., Campbell, S.M. Overweight prevalence and trends for children and adolescents: The National Health and Nutrition Examination Surveys, 1963 to 1991. Archives of Pediatrics and Adolescent Medicine,1995; 149:1085-1091. 4. Daily dietary fat and total food-energy intakes: Third National Health and Nutrition Examination Survey, Phase I, 1988-1991. MMWR Morbidity and Mortality Weekly Report. 1994; 43:116-117, 123-125. 5. Weight control: What works and why. Medical Essay. Mayo Foundation for Medical Education and Research, 1994.
   — DRutherford

June 18, 2002
Hi Nicole, email me a fax number or address and I will send you my appeal letters. Remember be a "pitbull" not a "poodle" in the tone of your letter!
   — ERICK B.

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