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What to include in an ins appeal letter? HELP!



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Just found out I was denied today. The bariatric center called and informed me. I have not received the denial letter myself so not sure exactly the reasoning. I know they mentioned more psych visits?? Bariatric center suggested that I compose a letter, along with one from the surgeon as to why this surgery is needed. If anyone has been in a similar situation and had success, please share your wealth of knowledge. I don't know what I could say that would help or be any different then what my surgeon would say. Feeling a little down today..

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I know when I wrote one it had every diet I had ever tried, how much I lost (if any) how long I had been over weight.

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I also had my doctor write a note saying the phrase "excellent surgical candidate" and how long she had seen me as well as a weight history. In addition to my surgeons letter

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I know fighting with insurance companies sucks. Fingers crossed for you. :-)

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find out exactly why they denied you and address those concerns item by item. You'll have a specific due date for your reply, so pay close attention to the calendar.

My first denial (I had two) was because of height inconsistencies in my medical records. Eventually, I did win.

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Just found out I was denied today. The bariatric center called and informed me. I have not received the denial letter myself so not sure exactly the reasoning. I know they mentioned more psych visits?? Bariatric center suggested that I compose a letter' date=' along with one from the surgeon as to why this surgery is needed. If anyone has been in a similar situation and had success, please share your wealth of knowledge. I don't know what I could say that would help or be any different then what my surgeon would say. Feeling a little down today..[/quote']

Wow I thought I was the only one with having problems getting my surgery. I was denied now 2 times!!! Its very frustrating and annoying. My insurance said the 1st time that I have to be seen by the dr for 6 months so I did that then the next month literally a day before my surgery the insurance company actually called me which they didn't the first time. And told me I'm denied yet again BC of not having a 6 month diet program like going to a gym. This was yet a bs excuse they just didn't want to pay for it. Now I had to switch my insurance *** so I'm praying that I have my surgery sometime in July. I do have to give credit to my Dr and the lady that has been fighting for NY surgery. I really do need this even though I have been doing my 2 week diet and how I just try to follow that so I do loose more weight before surgery. I will pray everyone else having surgery will hopefully not have to go threw what I am going threw.

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Just found out I was denied today. The bariatric center called and informed me. I have not received the denial letter myself so not sure exactly the reasoning. I know they mentioned more psych visits?? Bariatric center suggested that I compose a letter' date=' along with one from the surgeon as to why this surgery is needed. If anyone has been in a similar situation and had success, please share your wealth of knowledge. I don't know what I could say that would help or be any different then what my surgeon would say. Feeling a little down today..[/quote']

Jessica..hang in there even though its hard to. I. believe we both have the same insurance company ( BCBS of MN) if I read that right in a post on a thread I started a couple weeks back. I too was initially denied and an appeal started within a two week period. My surgeon appealed it and since everything was handled by the insurance specialist at Bariatrics, I have no idea what was written. Today, after 3 weeks since appeal was started, I got my approval today. I haven't received a letter yet from insurance company, but my insurance specialist called and told me the news. So there is hope!!! July 29 is my surgery date and I am so ready!

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    • LeighaTR

      I am new here today... and only two weeks out from my sleeve surgery on the 23rd. I am amazed I have kept my calories down to 467 today so far... that leaves me almost 750 left for dinner and maybe a snack. This is going to be tough for two weeks... but I have to believe I can do it!
      · 0 replies
      1. This update has no replies.
    • Doughgurl

      Hey everyone. I'm new here so I thought I should introduce myself. I am 53y/o and am scheduled for Gastric Bypass on June 25th, 2025. I'm located in San Antonio, Texas. I will be having my surgery in Tiajuana Mexico. I've wanted this for years, but I always had insurance where bariatric procedures were excluded. Finally I am able to afford to pay out of pocket.  I can't wait to get started, and I hope I'm prepared for the initial period of "hell". I know what I have signed up for, but I'm sure the good to come will out way the temporary period of discomfort and feelings of regret. I'd love to find people to talk to who have been through the same procedure or experience before. So I look forward to meeting you all. Hope you have a great week!
      · 1 reply
      1. Selina333

        I'm so happy for you! You are about to change your life. I was so glad to get the sleeve done in Dec. I didn't have feelings of regret overall. And I'm down almost 60 lbs. I do feel a little sad at restaurants. I can barely eat half a kid's meal. I get adults meals often because kid ones don't have the same offerings at times. Then I feel obligated to eat on that until it's gone and that can be days. So the restaurant thing isn't great for me. All the rest is fine by me! I love feeling full with very little. I do wish I could drink when eating. And will sip at the end. Just a strong habit to stop. But I'm working on it! You will do fine! Just keep focused on your desire to be different. Not better or worse. But different. I am happy both ways but my low back doesn't like me that heavy. So I listened (also my feet!). LOL! Update us on your journey! I'm not far from you. I'm in Houston. Good luck and I hope it all goes smoothly! Would love to see pics of the town you go to for this. I've never been there. Neat you will be traveling for this! Enjoy the journey. Take it one day at a time. Sometimes a few hours at a time. Follow all recommendations as best you can. 💗

    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      Officially here for a long time, not just a good time💪
      · 0 replies
      1. This update has no replies.
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