content of my appeal - or, some things I have learned about approvals

I finally got to speak to the insurance coordinator today.

I sent her a Strongly Worded Email and cc'ed the office manager last night. I got a return call at 11am this morning.

Issue 1: She explained that my PCP's chart has a height of 5'11 in it and that this was throwing off my BMI's. OK Fair enough. I thought it was sort of funny that they indicated that I needed to either be shorter or heavier in my denial letter. (I'm not overweight, I'm undertall, right?)

Philosophy: scour your chart for inconsistencies and errors and address them up front to eliminate any doubts for your insurance company.

Issue 2: I instructed her that since my policy does not have a clause about BMI's less than 40, I wanted them to specifically address the issue of physician-supervised weight loss to explain the periods of time in the past 5 years when I was at a BMI of less than 40: "despite not having the requirement to do so, this patient took it upon herself to participate in a physician-sponsored weight loss program not once, but twice. Upon the first discontinuation of the program, the patient regained weight to a value higher than her pre-program weight. Since the second discontinuation of the program, the patient's weight has risen x pounds."

Philosophy: the best defense is a good offense. 

Issue 3: The lack of communication from their office: I requested that they notify me when they send out the appeal. She said they'd email, and they anticipated it would be early next week.

Philosophy: Holding your breath waiting for someone else to do something means you'll pass out sooner or later.

So, I won't hold my breath, but if it does get to be Tuesday pm or Wednesday am, I'll put my crankypants back on and get back on the phone.

I'll cross my fingers instead.

Uh oh, it looks like your post cut off.

Are they going to correct your height? ( I am undertall too)

Thanks! I keep forgetting this software doesn't let me do greater than or less than signs. It thinks it's HTML. So yes, half my post was cut off. They'll be addressing my height, but I wanted to make sure that they addressed my physician-supervised work which has kept me at less than 40 periodically in the past 5 years, as well.

This is the story of my life - I have always been too tall, lol. I don't know where 5'11" came from. I would own 5'10", but on most days, I run 5'8" or so. I have shrunk in the past few years, no doubt from the weight. 

So they are resubmitting the corrected paperwork now? Cool. Good luck. Most denials I see are not true denials; they are because not all the correct information was submitted in the first place.

Seriously, if you have lost a couple of inches in height in the last few years, you need to get a DEXA scan!!!!

Good luck with the appeal ...