The appeal letter, and the insurance company:
An insurance appeal letter for gastric bypass surgery is something that we all dread doing, but may have to do, and there are literally thousands upon thousands of insurance companies, and every single one of them has extremely strict guidelines, especially when it comes to reimbursement.
The first thing you need to do is get ahold of your Insurance Company. Ask them what the guidelines are, who needs to refer you, and the amount of co-pay. I don't want to give out any false hopes, but many insurance companies will not cover gastric bypass surgery. When and if they say no, ask them if they make any exceptions...if there is a hesitation in their voice and they say no, ask to speak with a supervisor. When speaking to a supervisor use an even mellow and very polite tone. If you still don't get the answer you need, go into the provider in person and ask to speak with a manager. Be extremely nice and voice your concerns in a professional manner. If you still don't get the answer you want you will then need to file an appeal. I have compiled a list of helpful sites that can show you what needs to be done:
- http://www.sleh.com
- A complete site/turorial on the steps that need to be taken on an insurance appeal letter for gastric bypass. Very informative site.
- http://www.tuckthattummy.com
- Insurance issues and also a fantastic and helpful forum.
- http://www.wlscenter.com
- Basic but helpful site.
- http://hometown.aol.com
- An example of a letter.
- http://nshs.medselfed.com
- An audio clip.