ISO Appeal letter example

[lolarose13 147]

Hi guys,

So Aetna denied surgery conversion to bypass because they need "extra" proof of my GERD. They recently changed their rules and are asking for a PH Probe 24hr monitoring with abnormal results. I talked to my GI, and he told me that in order to do this test, I need to temporarily stop using medications that suppress stomach acid for about a week before the test; WHAT!? I can barely leave without them (I take a double dose, morning and night, and I am still waking up choaking most of the time, I have horrible reflux, etc.) and they will make me go through this just to prove that I have horrible GERD?

I talked to my doctor's team, and they believe I should file an appeal just to explain this unnecessary burden and suffering, as this is the first time an insurance company required this test. Does anyone have an appeal letter as an example that I can use to start this process? I'm just so upset about this is ridiculous.

Thanks!

[kcuster83 1,502]

Insurance companies are a joke. It is so irritating!

I hope you get is resolved without having to stop meds just to prove it.

I had severe GERD before my bypass (virgin bypass, not a revision) and I couldn't imagine stopping meds for even a day!

Flip side: Bypass has completely cured my GERD!

[summerseeker 1,844]

It has taken me 9 months to stabilise my GERD and nausea. I am also on 2 doses a day. I feel your pain. I would never want to go back to those horrid nightmare days of acid and broken sleep

[lolarose13 147]

08/24/2022 06:53 AM, summerseeker said:

It has taken me 9 months to stabilise my GERD and nausea. I am also on 2 doses a day. I feel your pain. I would never want to go back to those horrid nightmare days of acid and broken sleep

I feel you! 😫 I submitted an appeal
today, wish me luck! I will keep everyone posted 🤞🏻

[ShoppGirl 3,355]

Wow. That just sounds insane. Your probably gonna cost them more money than the surgery costs by ending up in the ER every night of that week seeking help to deal with the unmedicated GERD just to take their stupid test!! Not that they can necessarily even help you without those meds?? I really hope your appeal is approved.