Gastric Bypass Reference Guide

Gastric Bypass Appeal Letter for Insurance Company

If your insurance company denies your request that they cover your gastric bypass surgery, you always have the option of request an appeal. Here are some tips on filing an appeal for coverage of gastric bypass surgery:

1. Gather preliminary information:
   1. Get a copy of your insurance company’s original denial letter.
   2. Collect a list of those you can discuss the denial with, including medical professionals.
   3. Determine what specific procedures your insurance company requires (such as failed medically supervised diet attempts, psychological evaluations) before authorizing gastric bypass surgery.

2. Understand the disease of clinically severe obesity
   1. Be sure that the person who files the appeal (including you) understands the surgery and why it is necessary.
   2. Include forms such as a health status questionnaire to give the decision maker a better understanding of your daily struggles.
   3. Document past weight loss attempts.
   4. Educate the insurance company by adding peer-reviewed clinical journal articles that support your case.

3. Write the gastric bypass appeal letter
   1. Tell the insurance company that you disagree with their decision and why you believe that they should cover the procedure. Be sure to include in the letter:

                                                               i.      Your name, Social Security number, policy number, group number, claim number, or other information used to identify the case.

                                                             ii.      The company’s reason for the denial as stated in the denial letter.

                                                            iii.      A brief history of clinically severe obesity and the necessary treatment.

                                                           iv.      If you believe that the decision was made because of an error, state the correct information.

                                                             v.      Discuss why you believe the decision was wrong.