Question:

   — figuringthingsout (posted on August 13, 2009)

August 13, 2009
I had to write 2 appeal letters to my insurance co just to get my RNY. It sounds like your doctor needs you to provide your insurance company with the daily life complications you experience from your stretched muscle wall and excess skin. I found the best way to write letters (for anything) is to list key points that you want them to know. In this case, make a list of the things you can't do because of your current physical condition, i.e., pain upon lifting anything over "x" lbs because your doctor told you this could cause a life-threatening situation (if that's the case, I don't know and am only saying this as an example). If bending and or stooping are difficult, describe vividly what happens like the skin folds upon itself becoming pinched causing nerve pain, etc. If walking or other forms of exercise are impossible then definitely say so and again describe why (the weight of the excess skin is causing tearing). And if moderate daily movement causes perspiration that gets trapped under the skin fold and causes rashes then definitely state that as well and send in pictures if you have them along with the number of times you were treated by your doctor, what meds were prescribed for it, etc. I would list my difficulties from least troublesome to most difficult and/or dangerous to your health so that the most critical need for this surgery is the last thing they read in your letter and therefore be the predominant thought as they begin deliberating whether to approve or not. Just stress as much as possible how hard daily life is in your current condition. You have to basically prove to them you can't overcome these difficulties any other way than this surgery. Good luck to you, I hope you get approved as the more these insurance companies approve, the more likely the trend will occur in all the plans as part of the weight loss journey. Which is as it should be because muscles won't grow back together. Heck, I think it should be a covered benefit just from giving birth. A reward for the trouble & pain we go through. LOL
   — Arkin10