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Help With Appeal Letter

New to site I've been approved for lap band or the gastric bypass, I was rejected for the sleeve by highmark Bcbs of Pa. I am trying to write my first appeal letter. Does any know or were I can get help writing a good appeal letter any help would be greatly appreciated. My bmi is 42 they said I need to be above 50. Thanks

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Holy crap 50. I hate the insurance comp. will your surgeons office take the lead on the appeal??

Yes, but there seems a lot of experience here with people dealing with highmark bcbs.

What about any other factors like diabetes?

Consider getting a couple of the other tests that demonstrate a more accurate body fat percentage, and have them guesstimate how much more fat that would be at 50 bmi,

list your body measurements, your meds, how it impedes everything from sleeping normally to grooming and being winded, worrying about falling down, if you even suspect arthritis list it...and if it is substantial a list of copays fir appointments, meds and such and how that is anticipated to decrease,,,just suggestions.

I was self pay.

Hi...i have the same insurance(highmark)....nd my surgeon said he was gonna try to get me approved by doin a peer to peer..

My last visit for the 6months nut nd exercise is nxt week...i wanted to ask you were your 6months visit consecutive?!did u skip an appointment?! Becuz i went 01,02,04,05,06,07....notice how i skipped 03(march)...i keep thinking ill get denied becuz of tht...

  • 6 months later...

How did it work out for you?

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