Re: Appeal letter help, Please

[Guest guest]

In a message dated 7/26/2000 6:32:41 PM Eastern Daylight Time,

lindat@... writes:

<< First and foremost, find out *why* you were denied. >>

,

The letter says " obesity treatment is specifically excluded from

coverage. " My insurance paperwork says: SOME EXCLUSIONS: Services which are

not medically necessary or medically appropriate: weight loss programs,

weight loss drugs and weight loss surgery. I can't find anything in the

paperwork about " morbid obesity. "

Cathy in Lenoir, NC

5' 0 "

216.5 Lbs.

BMI 42

A journey of a thousand miles begins with a single step

[Guest guest]

Hi!

It is important to find out exactly why you were turned down. You may

not need an appeal letter at all.

If it is because they require x, y, and z and you only sent x and y,

then sending them z will get you approved, and in such a case, sending

them an appeal letter won't do anything but waste your time.

First and foremost, find out *why* you were denied. If they say it is

because it isn't " medically necessary, " then that means that something

on their list of criteria was missing. Ask them what was missing.

You can do this on the phone. Be persistant. Don't take " I don't know "

or " I can't find it " as an answer. If someone says " I don't know, " then

ask to speak to a supervisor or the person " handling the file. "

At every phone call, get the person's name you talk to and make a note

of the date and time, the person's name, and what was discussed (you may

need this later).

If the person you are talking to won't tell you who their supervisor is,

ask to be transferred to " the receptionist. " Then ask the receptionist

who that person's supervisor is (remember, you got the person's name,

right?) Or ask who is head of the pre-certification department, then

ask for the person's extension (so you can call them directly next

time). Then ask the receptionist to transfer you.

When you get a supervisor, first, get the full name (make a note of the

date, time, name). Ask why you were denied and ask what you need to

send them to be approved. If you get the runaround again, do the same

thing, ask the person who his/her supervisor is or who " handles the

file, " and get the extension number to call them. If you can't get it

from that person, ask to be transferred to the receptionist and ask the

receptionist who is the supervisor for that person (or who is the head

of that department) and what is the person's extension number.

Kind regards,

(another attorney)

CMo6331945@... wrote:

>

> Hi Everyone,

> United Healthcare of NC has turned me down on Dr. R's initial

> request,

> Debbie is in the process of mailing me his appeal letter to put in a

> packet

> to send to them, she advised me that I should also send a personal

> appeal

> letter to. (the attorney) was kind enough to send me a copy of

> hers,

> would anyone else be willing to let me see their's so I can get some

> ideals.

> I'm not a very good writer or very eloquent and I would really

> appreciate the

> help. I want so bad to have this surgery!!!!!!!!!!!

>

> Cathy in Lenoir, NC

> 5' 0 "

> 216.5 Lbs.

> BMI 42

> A journey of a thousand miles begins with a single step

[Guest guest]

Cathy, Do exactly as says. It Works! Just ask me!

Dinah in Alabama

Approved and thinking of a date!

> >

> > Hi Everyone,

> > United Healthcare of NC has turned me down on Dr. R's

initial

> > request,

> > Debbie is in the process of mailing me his appeal letter to put

in a

> > packet

> > to send to them, she advised me that I should also send a personal

> > appeal

> > letter to. (the attorney) was kind enough to send me a copy

of

> > hers,

> > would anyone else be willing to let me see their's so I can get

some

> > ideals.

> > I'm not a very good writer or very eloquent and I would really

> > appreciate the

> > help. I want so bad to have this surgery!!!!!!!!!!!

> >

> > Cathy in Lenoir, NC

> > 5' 0 "

> > 216.5 Lbs.

> > BMI 42

> > A journey of a thousand miles begins with a single step

[Guest guest]

Hi Cathy: I do so hope that you win your appeal. You have been one of the most

dependable

and supportive people on this sight for a long time now. I have watched and

waited hoping

that your turn would be coming soon. I didn't have to appeal so I don't have a

sample letter

but wanted you to know that I will be thinking of you and hoping that you will

be able to get

this surgery. I can tell you are a wonderful person..and we've never met...and I

do so hope

that you succeed!

Flo

> ** Original Subject: RE: Appeal letter help, Please

> **

> ** Original Date: Wed, 26 Jul 2000 17:29:09 -0400

> ** Original Message follows...

>

> Hi Everyone,

> United Healthcare of NC has turned me down on Dr. R's initial request,

> Debbie is in the process of mailing me his appeal letter to put in a packet

> to send to them, she advised me that I should also send a personal appeal

> letter to. (the attorney) was kind enough to send me a copy of hers,

> would anyone else be willing to let me see their's so I can get some ideals.

> I'm not a very good writer or very eloquent and I would really appreciate the

> help. I want so bad to have this surgery!!!!!!!!!!!

>

> Cathy in Lenoir, NC

> 5' 0 "

> 216.5 Lbs.

> BMI 42

> A journey of a thousand miles begins with a single step

>

>

>

> This message is from the Mini-Gastric Bypass Mailing List at Onelist.com

> Please visit our web site at http://clos.net

> Get the Patient Manual at http://clos.net/get_patient_manual.htm

>

> To Unsubscribe Send and Email to: MiniGastricBypass-unsubscribe (AT) egroups (DOT) com

>

>** --------- End Original Message ----------- **

>

Florence Ballengee

Hollywood, land

florence@...

Download NeoPlanet at http://www.neoplanet.com

[Guest guest]

In a message dated 7/26/00 3:43:13 PM Pacific Daylight Time,

florence@... writes:

<< I didn't have to appeal so I don't have a sample letter

but wanted you to know that I will be thinking of you and hoping that you

will be able to get

this surgery. I can tell you are a wonderful person..and we've never

met...and I do so hope

that you succeed!

>>

Hi Cathy,

My post-eating computer did not have your original post. Were you looking

for an appeal letter? Have I sent you mine?

Regards,

Debbie in IL

Daughter MGB 8/9 Cigna (3rd appeal)--BMI 45

Counting on Cigna for Debbie (BMI 40) First request denied 7/21 :0(