Question:
Could you please send copies of your insurance apppeal letters?

My best friend, who has Cigna Healthcare Southern California, just recieved a denial letter. She most certainly qualifies for this surgery on BMI alone. ARGH. If you have copies of your appeal letters, could you please send them to me - so she and I can draft a letter to the insurance? Any other helpful hints on the appeal process would be appreciated as well. Thank you all!!    — MissKimberly (posted on February 23, 2003)

February 23, 2003
The first thing you need to find out is why she was denied. Was it because of an exclusion in the policy? Do they just want more documentation? Did her surgeon send in the right codes? You didn't say what her BMI is, but does her insurance have specific criteria for BMI and/or comorbs? If it's just more documentation or a matter of the surgeon not giving enough information, the surgeon's office should be able to take care of that.<p>I know there are people who disagree with this, but if she does need to send in an appeal letter, keep it brief and only address the reasons she was denied. Remember that the people who review those are very busy and don't have time to read pages and pages on the emotional and physical pain her weight has caused her. Ditto for letters from spouse, children, etc. You may know that people who write about job hunting tell you to keep your resume to one page? Well, it's the same principle. If you got 10 pages or more, how likely would you be to read it all? JMHO.
   — garw

February 23, 2003
Gar is absolutely right on every point.
   — koogy

February 23, 2003
She was denied because they stated she has not completed a "supervised weightloss program in the last 12 months". However, she did do optifast with this insurance carrier 4 years ago, lost 80 pounds, and gained it back. Can they really expect her to put her body through that again? And it obviously failed....why would she do it again? Perhaps a letter from her MD would help? Just looking for direction here....thanks again all!
   — MissKimberly

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