Question:
I need everyone's help please!!

I have been denied and I am in the process of appeal. I have to write a kick butt appeal letter and I am asking for your help on this. They denied me because they said that there wasn't enough clinical evidence that I needed this surgery.Can you believe this? I do have cormorbidities such as Acid reflux, Arthritis of the knees, high cholesterol and triglycerides, back pain, constant leg pain and swelling, so aside from being 120 pounds overweight I thought these were enough evidence.Please e-mail me with examples or ideas, I need all of the help I can get. I don't want another deniel. thanks~ REBECCA LEFEBVRE    — REBECCA L. (posted on August 16, 2001)

August 16, 2001
Can you have a sleep study done? If you have sleep apnea you would probably be approved much quicker. Also, ask your doctor about diabetes screening. If you are 120 pounds overweight, you run a high risk of type II diabetes. That may also give you an edge in getting your surgery approved. If you have both, that may be the clincher. Good luck. Maria
   — Maria H.

August 16, 2001
Hi!! Have you tried listing the day to day activities that are hard to do? Besides from the medical reasons. Ask "them" (the insurance) how long they would be able to carry around a 120 pound sack of sand, half in front and half in back, and see how they feel after that! I wish you the best of luck, please let me know what happens! [email protected]
   — Lisa G.

August 17, 2001
They are seeking "clinical" evidence. In other words all the medical notes you can get from every Dr you've seen that will address your comorbidites is best. Good luck.
   — Dawn R.

Click Here to Return