Question:
I am sending out my appeal this afternoon and I need some oppinions
I have posted all the information I am sending to Tricare for appeal this afternoon on my profile. If you would please take the time to look at it and tell me what you would add to it or what you would take out of it. Thank you all very much. I was denied due to lack of diet history and no supervised weight loss programs. — S C. (posted on June 17, 2003)
June 16, 2003
I cant believe you are going through all this. I would contact the Lawyer
this site recommends and advertises. I emailed him regarding my situation
with Fortis Insurance Company and he responded very promptly and honestly
to my situation. It is rediculous that you should be appealing this
decision. If you have the money i would recommend switching to Anthem.
After being denied due to an exclusion policy by Fortis, I was aproved in
less than 2 days by Anthem Keycare of VA. Good luck!
— Kymberly H.
June 17, 2003
The only things I would add are a couple of statements: Given my extensive
family history of obesity, heart disease, diabetes and cancer, it seems
imperative that I be given the opportunity to be able to make the necessary
permanent changes, by way of gastric bypass surgery, to prevent the
development of these conditions in myself. Surely the cost of paying for
the surgery would outweigh the cost of treating any one of the above
mentioned conditions over my lifetime. And if necessary add: And, although
my BMI is relatively low, it seems very counterproductive that I gain
weight in order to qualify for surgery based on a number instead of need.
Remember that insurance companies are all about the $$$ Best of luck with
your appeal!
— koogy
June 17, 2003
Actually, the only thing I would OMIT would be the fact that your mother
and some other relatives who succumbed young to heart disease were not
obese. With how flakey your insurance company has been, I would hate for
them to see the reference that your close relatives' heart disease did not
appear to be obesity related and use that to say "well then, the
surgery won't help you there". I would certainly mention all relatives
who DID struggle with obesity, but I would NOT mention that some relatives
with significant health problems were NOT obese. Does that make sense? Good
luck to you - after all you've been through, you deserve some good luck!
— johanniter
June 17, 2003
— [Deactivated Member]
June 17, 2003
I think you need to really focus on how this weight is affecting you in
every day life. I am going to email you my personal letter that I sent to
my surgeon- Feel free to use any of the information that applies to you.
Good Luck.
— Jan S.
June 17, 2003
I sent out the appeal. I did take some of you guys advice I did not omit
anything but I did explain better about the fact that since the realtives
who didn't have weight problems had these problems that my problems would
be exasperated by the excess weight that I do carry. I am going to post the
letter that I sent to them on my page also. My insurance never said
anything about a supervised diet program or a diet program of any kind. The
exact words they used in my denial stated that there were no physician
supervised aggresive attempts at weight loss. My insurance does not cover
any form of weight loss other than this surgery. I get three appeals the
first one I could have choosen to do in three days(I have three days to get
it back to them and they have three days to give me an answer)or I could
take the other way which is that I have 90 days to appeal and they have 30
days to give me an answer. If I am denied this time I will take the longer
amount of time. I am seeing my PCM on the 24 and I am going to ask him to
put me on an aggresive weight loss plan that will be physician supervised
if he won't I will have it write it down in my record that I did ask for it
and he denied it, otherwise I will go on the plan and hope to lose the
weight with no hope to actually keep it off, but if I don't then I have a
means to fight for the surgery. Thank you all for your help.
— S C.
June 17, 2003
Dont give up! I was denied approval as it was an exclusion to the group
insurance. Now mind you this is a large Medical Center in Chicago. After
speaking with the director of benefits and questioning the reason of the
hospital doing this surgery and accepting other insurances why would they
deny it for their own employees. After an appeal and a great Internist
they hospital is adding it as a covered benefit effective July 2003.
— STEVEN K.
June 17, 2003
I agree with the first poster, Susan. Insurance companies only want to see
how much money this procedure will eventually benefit them. Allison
— j A.
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