Denied Again. Help!!! Need official Appeal Letter
Hi Guys
So once again I call the insurance and they deny me again for the same reason. Non compliance with Diet and exercise. When I ask the lady to please be specific because I don't know what else they want from me. She tells me that she looked over the paper work and see that one month I was following a 1500 cal and then another month a 1800 cal and then back to 1500. HUH? So...... This is what my Doctor wrote and advise me to do. At first she felt like I should should start low but when she realize I was hungry a lot she adjust it to my size and Bmi. When I then started going to the nutritionist because my Doctor no longer practice she put me on a new and different diet to follow. I provided them with all the info from the Old Doctor and new doctor and yet its still a problem. Now I need to appeal and need help on doing so. I already have the address on where to send my letter too. I just need to know how to plead my case. I even went to my gym and got a copy of all the times I went to the gym day by day. I also spoke to my new nutritionist and she will be sending them all of her notes as well as all of the weekly food diary I kept since I started with her. Once again I want to just break down and cry but my anger wont let me. I just don't understand how this health care system works. I bust my ass and pay them almost a 100 every two weeks for medical and when I now need help they tell me they can't help me. How dare them.
So once again I call the insurance and they deny me again for the same reason. Non compliance with Diet and exercise. When I ask the lady to please be specific because I don't know what else they want from me. She tells me that she looked over the paper work and see that one month I was following a 1500 cal and then another month a 1800 cal and then back to 1500. HUH? So...... This is what my Doctor wrote and advise me to do. At first she felt like I should should start low but when she realize I was hungry a lot she adjust it to my size and Bmi. When I then started going to the nutritionist because my Doctor no longer practice she put me on a new and different diet to follow. I provided them with all the info from the Old Doctor and new doctor and yet its still a problem. Now I need to appeal and need help on doing so. I already have the address on where to send my letter too. I just need to know how to plead my case. I even went to my gym and got a copy of all the times I went to the gym day by day. I also spoke to my new nutritionist and she will be sending them all of her notes as well as all of the weekly food diary I kept since I started with her. Once again I want to just break down and cry but my anger wont let me. I just don't understand how this health care system works. I bust my ass and pay them almost a 100 every two weeks for medical and when I now need help they tell me they can't help me. How dare them.
every state is different on how adverse determinations are handled. Some it is the dept. of health, some insurance commissioners. It really doesn't make a difference what was told to you on the phone, you know if it is not written down, means nothing. If you were denied, then you should get a letter telling you why you were denied, the exact reason (didn't meet medical necessity due to.....) take that information and compare it with the obesity policy and your specific adhesion contract (subscriber agreement) and look at them. look especially at the exclusion, coverage and the time limits for appeals. If you don't have these pieces of information it is your responsibility go get them, if not you will be going into the lion's den. you have to know your policy inside and out first before you begin an appeal and apply that to your adverse determination letter......wishing you well in your appeal....
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