Quote:
Originally Posted by My Life Back  Hi Denise -
I was wondering if it was possible that you could send me a copy of the information that you submitted regarding the National Institute of Health. I haven't been denied or accepted yet. I am still going back and forth with my PC to get the "proper" referral letter :confused2:. But I would like to be prepared in case they do hand down a denial.
I would greatly appreciate it.
Thanks so much in advance.
Becky |
Hi Becky,
The lack of a 6 month program is the only reason my insurance company quoted for my denial.
Here is the link to the NIH Opinion:
The National Institutes of Health (NIH) Consensus Development Program: Gastrointestinal Surgery for Severe Obesity
If you can see a copy of Weight Loss Surgery for Dummies, it has several ideas for an appeals letter. This is what I used as the basis for my appeal. I used my own info of course, but it was effective. I pretty much plagerized the part about the NIH in their example letter.
I said something along the lines that the NIH 1991 consensus on obesity surgery does not mention a 6 months physician supervised diet program as a requirement for obesity surgery. I went on to cover my co-morbidities and made copies of diary entries from previous diet attempts and also previous Weight Watchers attendance information.
I stated that will all of my previous attempts, one more is unlikely to produce sustainable results.
Good luck! I hope you do not need to file an appeal, but it is good to be thinking about what you will write if needed.
I sent it to my insurance company and my primary care doctor.
Denise
