Question:
Please Help, need some examples of appeal letters for my HMO!!!!

   — Donna S. (posted on August 28, 2001)

December 7, 2001
This letter is to serve as documentation of medical necessity for surgical treatment and associated medical care for the treatment of morbid obesity as outlined below. (MD)serves as the primary care physician for (your name), a 30 year old Hispanic female who suffers from morbid obesity. Her current weight is 242 pounds, height is five feet, 1.25 inches, this calculates to a body mass index of 45.8 . In addition to morbid obesity, comorbid conditions include hypertension, hypothyroid, asthma, dyspnea, and chronic back and hip pain. These comorbid conditions are directly related to her obesity. She also has a strong family history of Type II diabetes and her current blood sugar level is borderline high. (Your name) has already employed several weight loss measures unsuccessfully. These include home dietary regimens, Weight Watchers, Jenny Craig, medically supervised weight loss, nutritional consultations, prescription weight loss medications (Xenical and Meridia), regular exercise and personal training. Despite these efforts over the past 10 years, her weight continues to be a serious health problem. She is morbidly obese. She is also a registered nurse. Her weight has affected her ability to maintain a job as a floor nurse because of the physical requirements of working a 12 hour shift. This is a medically necessary referral for surgical consultation and possible surgical intervention for the treatment of morbid obesity, which may include gastric bypass surgery or vertical banded gastroplasy. It has been proven that surgical intervention for obesity in cases of refractory morbid obesity is the most effective and long-lasting weight loss measure available. If (your name) morbid obesity is not corrected, significant comorbid conditions will continue to develop.
   — blank first name B.