For many people, weight-loss surgery is a lifeline to a major life change. This surgery is considered by obese individuals who have tried a variety of other options for weight loss to no avail. Therefore, it can be a devastating blow when the surgery is denied, either by a physician or insurance company. In most instances, there is an appeals process that generally requires a great deal of documentation, including an appeal letter.
Instructions
1. Identify yourself in the opening portion of the letter. Include insurance information, contact information and other personal information that might help the person receiving the letter identify you and your particular case. You might also include a line recapping the reason for the letter and the denial decision.
2. Draft a list of concise arguments in favor of the surgery. You have to make the party that denied the surgery understand why it is important and crucial to your health to have this surgery. Therefore, you may have to work harder to make the party approving the surgery understand that you are genuine in your reasoning for needing it. Don't drone on about your wants; focus on facts about obesity. Discuss the benefit to your overall health, and keep your statements short and simple. If you have an existing condition due to obesity, such as hypertension or diabetes, and a body mass index (BMI) over 35, cite this information as well and include official diagnosis documentation.
3. List weight-loss methods you've tried previous to considering the surgery. In some instances, weight-loss surgery has been abused in some instances by people interested in getting this surgery for cosmetic reasons versus health need. You will need to list, in as much detail as possible, what you have tried and why it has not worked. If possible, list dates and contact information to authenticate the methods you are claiming to have tried. The more forthcoming you are in this letter about methods that have failed for you, the more likely it is that the decision regarding the surgery will be reversed.
4. Use quotes from supporting physicians in the letter. Ask your primary-care doctor for a letter of support, from which you can quote snippets in your letter and include the rest in your appeal package. You might also get a second opinion from a different physician for the same purpose. Professional support will lend more weight to your argument.
5. Include a personal statement on how being obese has affected your life. This is your time to talk about how being obese has effect your life on a personal level. Try to keep your language plain and simple. You are not trying to court sympathy here, but rather a more in-depth understanding from the party deciding the outcome of your appeal. You want to make them understand why you need this surgery to live a better life. Use anecdotes and stories illustrating the severity of your situation. Again, keep this portion clear and concise.
6. Edit and proofread carefully. Before you submit your appeal letter, look it over carefully. Read it once to make sure it makes sense and sounds logical. Then, read it again for grammar, spelling and any other errors you might spot. Have a friend or family member also read it over to give you their opinion on the tone of the letter overall; they, too, might spot errors that can keep your letter from look as well-thought out and executed as it should.
