Appeal

For those of you who have been denied and appealed, what did you do to win your appeal?  I was just recently denied because the insurance company feels that if I can lose 30 lbs in three months, I can lose the rest on my own...  I have decided that I will not be watching what I am eating any more until after my appeal because I don't want to give them a reason to deny me again because my BMI is too low for the surgery.  My BMI at starting was 48 and now is 41.5 and I have no comorbidities.  I do have a strong family history of hypertension and diabetes.  The only thing wrong with me is I have edema and back pain.  

Is there anyone out there that has appealed and lost?

Any help would be appreciated.

Hello,today my insurance denied my gastric by pass surgery. It is with anthem of calif. and my doctor though it would get approved, since I was just diagnosed withprediabetes, which is why I had been trying to obtain this surgery, most of my family has diabetes and its in their late 50's.My bmi is 39.5, and the insurance wants it to be at 40.  I am going to appeal, and I hope someone here can give us some direction.  My feet, back,and gurd are keeping me on so many medications, now new pills for my blood glucose.  there is not a day that I CAN'TMANAGE WITHOUTMY PAIN PILLS, THE GURD WILL BE CURED IFI GET SURGERY.Any one have any ideas, sample appeal letters.  please help.thank you 

Hello - I have Aetna insurance.  I had surgery and so did my three children.  Out of the four of us, two fo us were denied at first and my two sons were approved.  So I filed appeals on myself and my daughter and both decisions were overturned. 

DO NOT GIVE UP!  You can do this.  I filed the appeal myself, not my physician or the surgeon's office.  I took the clinical bulletin and went through point by point the requirements they were looking for and I proved that I had met every one of the requirements. 

I will send you a PM with a copy of the appeal letters I used from both myself and my physician.  You can change them around and word them with your cir****tances or use them as a starting point.

Don't give up, as long as you have met the requirements, you have a good chance of getting approved if you appeal. 

Good Luck,
Nan

I was also denied the first round.  My doctor called my ins. company and fought to get it overturned.  I'd ask your doctor what they can do.

Insurance denied me because I have not been with medcailly superivsor weight program for 6 months started last Friday. I weight my BMI is 40.8. My insurance amerigroup want me 10% weight loss that mean I must lost around 21 lbs almost go down 200 lbs with 40 BMI. I am 5'3 height. Once 6 months done next year March 2012 I hope to get approval from insurance because I have family history diabetes type 2 and I have hurt my back pain and anierixty depression.