Appeal Letter to insurance company that denied me coverage..looking for feedback

[Guest guest]

Highmark Security Blue

Appeals Department

P.O. Box 535047

Pittsburgh, PA 15253-5047

To Whom It May Concern:

I was recently denied coverage for a prescription. The medication is

Testosterone Enanthante. I have been taking this medication for over two years.

I was initially turned down because you didn't have my current blood work. My

Endocrinologist, Doctor Jill Felder, forwarded you the information, and I was

turned down again. If your reason for turning me down was based on my current

blood work, then you made an error. I'll always test in the upper normal range

as I am currently taking Testosterone. The reason I need to go through this

process is I switched to Security Blue this year after being with UPMC for Life

the previous few years. They approved me being on Testosterone and renewed the

approval each year.

Having been on exogenous testosterone, my testicles have shut down from making

any, and have also atrophied somewhat. This is a normal side effect of being on

testosterone, and I expect I will be on it for the rest of my life. If you

continue to deny my claim, my body will run out within a week or two after my

last injection. If this happens I would likely experience the following:

* Osteoporosis

* Diabetes

* Mental fog or a lack of concentration

* A lack of ambition

* Inability to focus

* Loss of muscle mass and fat redistribution

* Weight gain

In 2003, I was diagnosed with diabetes. It took a combination of losing weight,

Actos, and Testosterone all working together to keep my blood sugar under

control. Testosterone helps regulate blood sugar.

In 2005, I was diagnosed with osteopenia in my spinal column. Again

testosterone helps maintain strong bones. I also take calcium and Boniva. It

was due to low testosterone (hypogonadism) that led to me becoming permanently

disabled in 2000. I need to be on testosterone to maintain my bones and

strengthen the weakened bones in my spinal column.

When I went on testosterone, I regained a mental decisiveness and clarity that I

hadn't realized I had lost over the years. This enabled me to take control of

my life and not just go through the motions. If my body went into a

testosterone crash, I'd lose my mental sharpness, possibly falling into a severe

depression. I'm already physically disabled; I need my mental clarity to have a

reasonable quality of life.

Sincerely,

K. Woolf