Need Help WIth Appeal!

Sandra N.
on 2/11/08 10:43 pm - MN

I need help in appealing my insurance's decsion. Any advice? How? Thanks!

~Sandie~ -147!!WLS:12-12-06:Preop 268,Ht.5'4",BMI 44.9
Click on link to see my journey!!!
http://www.onetruemedia.com/my_shared?z=2bfaca5561a1d558fceb
87&utm_source=otm&utm_medium=text_url
"Do unto others as you'd have done to you"~ The Golden Rule to Live by!
You are what you EAT and WHO you hang out with! Choices=Outcome~ what's YOUR choice??
I'm not perfect but I am going to die trying!!!

ReneeW
on 2/12/08 7:50 am - IL

RNY on 03/03/08

One question, when they sent your denial, why did they deny you?

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Sandra N.
on 2/12/08 8:54 am - MN

RNY on 12/12/06

They said they felt it wasn't medically nesseccary (even with all the documentations, pictures of the rashes, letters of recommendation from my PCP and PS).

~Sandie~ -147!!WLS:12-12-06:Preop 268,Ht.5'4",BMI 44.9
Click on link to see my journey!!!
http://www.onetruemedia.com/my_shared?z=2bfaca5561a1d558fceb
87&utm_source=otm&utm_medium=text_url
"Do unto others as you'd have done to you"~ The Golden Rule to Live by!
You are what you EAT and WHO you hang out with! Choices=Outcome~ what's YOUR choice??
I'm not perfect but I am going to die trying!!!

SCushway
on 2/12/08 10:34 pm - Daphne, AL

RNY on 02/21/08

who is your insurance? And what is the criteria you have to meet to qualify for the surgery? Did you meet each and every thing and have it documented? I can send you my appreal letter just as a starting reference. Not that everything in my letter would apply to you, but it would give you a starting point. I was denied at first for the same reason and I knew I had met ALL of their criteria so I appealed and got approved. PM me if you want to see my letter. You can customize it to fit your needs. Sandi

Sandra N.
on 2/15/08 11:42 pm - MN

RNY on 12/12/06

Hi Sandi!! Sorry I am late in getting back to you (I ended up in the hospital with gall bladder removal). My insurance is BCBS of MN. This is what the denial letter said: "The Medical Policy Committee has determined that a Panniculectomy and Medial Thigh Lift are not considered medically neccessary except when the member has chronic, recurrent skin infections that are unresponsive to medical management or treatment AND interference with hygiene and activities of daily living. The documentation that was submitted for our review did not meet these criteria. Therefore, the requested services are not eligible for coverage." UM, HELLOOO!! I had 2 doctors stating the recurrent, not responding, hygiene issues!! Talk about frustrating!!! I would sooo love to see an example of your letter! Thank you soo much for your help!

~Sandie~ -147!!WLS:12-12-06:Preop 268,Ht.5'4",BMI 44.9
Click on link to see my journey!!!
http://www.onetruemedia.com/my_shared?z=2bfaca5561a1d558fceb
87&utm_source=otm&utm_medium=text_url
"Do unto others as you'd have done to you"~ The Golden Rule to Live by!
You are what you EAT and WHO you hang out with! Choices=Outcome~ what's YOUR choice??
I'm not perfect but I am going to die trying!!!

gary viscio
on 2/23/08 2:00 am - Oceanside, NY

RNY on 07/01/03

Thats BS. Do a great letter and use the 1991 nih criteria

Gary Viscio
www.ObesityLawyers.Com
RNY 7/1/03 -166lbs

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Need Help WIth Appeal!