ThinnerTimes - Gastric Bypass and Lap Band® Forum - View Single Post

Zenomia · 12-05-2006, 01:06 PM

Quote:

Originally Posted by Baron Patrick

Thanks for the suggestions. I made some revisions (in bold):

I have been obese since my early teen years. Having experienced various diets, and exercise programs throughout my life have proven to be ineffective. My doctor instructed me to join Weight Watchers, as it was her understanding this will satisfy your requirements. I have been diligent in ensuring I completed this six-month monitoring, along with periodic follow-up with my doctor. This documentation was also submitted to you.

I did not decide to become obese. Nor did I wake up one day and decide to have weight loss surgery. I have researched bariatric surgery for over a year, and discussed this at length with my family. I believe my case of medical necessity has more than been established based on your current guidelines. I am asking you to please review, and reconsider your decision.

You might want to add that you discussed it not only with your family, but your physician. Try, though I know it's hard, to keep the personal sentiments OUT of your letter for appeal. Instead of saying this documentation was submitted, say instead that you will include the documentation required. (Even though it has been provided previously...they won't want to search for anything...if it's at their fingertips, it won't get sidelined!) Also, a letter from your physician, stating plainly that you have been monitored for more than just the 6 months for weight and weight related health issues...ie: Type 2 Diabetis, will do a lot more to forward your case.

I have learned that they insurance companies don't care about your feelings or what you have gone through, they don't see you as a person. They see you as a Bottom line, and as such, you need to approach this letter as what you have done and how you have accomplished all their hoops and then some. They won't care about your 'feelings' they care about your Drs. reports, and your proof that you did what they deemed as 'required' for surgery and then some. I don't mean to sound discouraging, I just want you to have the best possible chance at getting this approval that you can!!

You have worked way to hard at this Pat....don't give up now....hop, skip and jump...they will HAVE to take you!! Soon sweetie...soon!!