Gary HELP PLEASE

I have been denied for RNY the letter states  The requested weight loss surgery does not meet medical policy, The criteria allows weight loss surgery for BMI of less than 40 if the patient has documentation of related serious medical problems not responsive to other medical treatment. Additionally, the condition of morbid obesity must be at least two years duration, The documentation does not support these criteria. the medical policy states:   the patient must have a BMI greater than 40. Patients with a BMI 35-40 will be considered when there is documentation of a co-morbid condition, such as hypertension refractory to standard drug regimens, cardiovascular disease, degenerative joint disease, documented obstructive sleep apnea, severe persistent asthma, or diabetes,    the condition of morbid obesity must be 2 year duration.  Ok so after being denied I when to the doctor more than anytime in my life. We found Moderate sleep apnea requiring a CPAP machine and early degenerative joint disease requiring physical therapy. Is this info helpful to me and how do I gt started with an appeal. how do I set up the letter.  Thank you for your help! Tamara

The info you have is good.  You should make sure your doctor submitts all of your information and your appeal letter should address each requirement and how you meet those requirements.

One caveat:  please ensure also that you meet the requirement for being morbidly obese for at least two years in addition to the co-morbidities that your provider is submitting.  Otherwise, the insurance company is going to kick back to you again.